Evaluation of outcomes after implementation of an induction-of-labor protocol

Abstract

The purpose of this study was to determine whether adherence to an induction of labor (IOL) protocol decreases the rate of failed IOL (FIOL). We performed a 1-year retrospective chart review around the implementation of a hospital IOL protocol and compared maternal and neonatal outcomes from deliveries managed per protocol (n= 369) with those deliveries that were not (n= 230). Women at least 24 weeks' gestation with cervical dilation up to 2 cm who underwent an indicated IOL were included. Protocol-adherent (PA) inductions had amniotomy within 24 hours of starting oxytocin, intrauterine pressure catheter placement in latent labor, Montevideo units titrated to 200-300 or to adequate cervical change, and oxytocin administered for at least 12 hours after amniotomy before FIOL was diagnosed (defined as delivery by cesarean during latent labor as a result of failure to enter active labor). The primary outcome was the rate of FIOL. Control for possible confounders was made by stratification and multivariate modeling. FIOL rates were lowest in the PA group, which remained significant after stratification on parity and multivariate analysis (nulliparous women, 3.8% vs 9.8%; P= .043; multiparous women, 0% vs 6%; P < .0004). Median time to delivery was shortest in the PA group by 3.5 hours in nulliparous women (16.0 vs 19.5 hours, respectively; P= .0002) and 1.5 hours in multiparous women (10.75 vs 12.25 hours, respectively; P < .0001). There were no differences in infectious morbidity or neonatal outcomes between the groups. Adherence to a standardized IOL protocol is associated with a decreased rate of FIOL and length of labor.