Timing of initiation of cervical ripening and its effect on time of delivery

Abstract

Increasing staff shortages despite a rise in patient numbers has led to congestion on our L&D unit resulting in delays in scheduled inductions. Our staffing model differs from day to night with regard to number of nurses, residents, attending physicians, and ancillary staff present. While staffing is more limited during nighttime hours, our patients undergoing daytime cervical ripening are more likely to deliver during the night. We sought to examine if shift of admission for cervical ripening impacted the time of delivery. We completed a retrospective cohort study of singleton pregnancies at our institution delivered January-December 2018. We included viable pregnancies with cephalic presentation requiring cervical ripening. Bishop score ≥6 was excluded. Cervical ripening was completed with misoprostol or foley balloon. We excluded history of prior cesarean section, gestational age < 37 weeks, multiple gestations, and contraindication to vaginal delivery. Primary outcome was shift of delivery. Multiple logistic regression was performed to evaluate the relative impact of BMI, parity, and cervical exam on time to delivery. Significance defined as P< .05. 450 patients met inclusion criteria. Patients were divided into those with day (7am-7pm) and night (7pm-7am) deliveries. The majority of our population was nulliparous (59%) with admission dilation of 1cm (44%). We found no statistically significant difference in time of delivery based on shift of admission for cervical ripening. We did find statistically significant differences in time from admission to delivery based on parity, cervical exam on admission, and BMI. Our data show shift of admission for cervical ripening does not impact shift of delivery. BMI, parity, and cervical exam on admission do influence length of induction to delivery. These patient characteristics may be used to predict the length of time a patient will be on L&D and help time inductions to optimize delivery to match staffing and improve L&D flow. Development of a predictive model for induction to delivery timing is currently being studied.View Large Image Figure ViewerDownload Hi-res image Download (PPT)