617 A novel evidence-based labor induction algorithm associated with increased vaginal delivery within 24 hours

Abstract

To assess whether adherence to our proposed labor induction algorithm is associated with an increased rate of vaginal delivery within 24 hours. After creating an evidence-based labor induction algorithm, we conducted a retrospective review of 287 labor inductions at a single urban, tertiary, academic medical center. Patients were included who were age 18 or over and had a singleton, cephalic pregnancy of 36 6/7 to 42 0/7 weeks’ gestation. Patients were excluded with Bishop score >6, any contraindication to misoprostol or cervical Foley catheter, or who’s fetuses suffered major fetal anomalies (defined as cardiac, thoraco-abdominal, abdominal wall, or any central nervous system anomalies present at time of delivery) or intrauterine fetal death. Patients with algorithm-concordant inductions were more likely to have a vaginal delivery within 24 hours, 85.7% vs. 57.1% (p<0.0001), with an adjusted hazard ratio (aHR) of 2.72 (1.98, 3.75, p<0.0001). Algorithm-concordant patients’ time from first intervention to delivery (i.e. induction-to-delivery time) was shorter, 11.9hrs (IQR 7.5, 15) vs. 19.4hrs. (IQR 13.1, 26.5). Patients with 100% concordant inductions trended towards a lower rate of cesarean delivery (11.7% vs. 21.4%) (p=0.0614). Patients with algorithm-concordance 80% or greater had a significantly lower rate of cesarean delivery (11.5% vs. 22.5%) (p=0.0238). There were no differences in the neonatal outcomes assessed. In our review of 287 labor inductions, use of our proposed labor induction algorithm was associated with an increased rate of vaginal delivery within 24 hours with an aHR of 2.72, and a significantly shorter time to delivery. Algorithm-concordance of 80% or greater was associated with a significantly lower rate of cesarean delivery. Our labor induction algorithm may offer an opportunity to standardize care, improve the rate of vaginal delivery within 24 hours, shorten time to delivery, and reduce the cesarean delivery rate for patients undergoing induction of labor.View Large Image Figure ViewerDownload Hi-res image Download (PPT)