685: Can a standardized labor protocol for induction reduce adverse outcomes without increasing risk of cesarean?

Abstract

To evaluate the impact of a labor protocol on reducing maternal and neonatal morbidity in women undergoing an induction of labor (IOL) with an unfavorable cervix. As part of a planned secondary analysis, we compared maternal/neonatal morbidity between women in a large randomized trial on IOL (n=488) that included a detailed labor protocol to women in an observational cohort (n=362) enrolled at the same time where labor was managed at the discretion of the provider. The labor protocol included standardized and active management of latent/active labor and encouraged close attention to the rate of cervical change with recommendations for interventions at particular time points (eg. Oxytocin, intrauterine pressure catheter, amniotomy, cesarean). Term (≥37 weeks) singletons with intact membranes and unfavorable cervix (dilation ≤2cm, Bishop score ≤6) were included. Adjusted relative risk (RR) of cesarean, maternal morbidity, NICU admission, and NICU admission >48 hrs was estimated using modified Poisson approach. Adjusted incident rate ratios (IRR) for length of stay (LOS) were estimated using Poisson and negative binomial models. Demographic characteristics (eg. age, BMI, insurance) were different between protocol and observational groups but clinical characteristics were mostly similar (gestational age at IOL, indication for IOL, co-morbidities, Bishop score). Median cervical dilation at the time of induction was slightly greater in the protocol group (1cm [1-1.5] vs. 1cm [0.5-1.5], p<0.001). When comparing differences in adverse outcomes, there was a decreased risk of maternal morbidity and a shortened neonatal LOS in the protocol group (Table). However, there were no differences in risk of cesarean, maternal LOS, or NICU admission. Use of a standardized and active management labor protocol for women undergoing a term IOL with an unfavorable cervix is associated with a reduction in maternal morbidity and neonatal length of stay without an increase in cesarean.