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Am J Perinatol 2024; 41(S 01): e3140-e3146
DOI: 10.1055/a-2195-6063
Original Article

An Externally Validated Model to Predict Prolonged Induction of Labor with an Unfavorable Cervix

Authors

  • Tetsuya Kawakita

    1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

  • Haleema Saeed 

    2   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia

  • Jim C. Huang

    3   Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan

Funding The data included in this paper were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH) through contract number HHSN267200603425C. This project was funded in part with Federal funds (Grant # UL1TR000101 previously UL1RR031975) from the National Center for Advancing Translational Sciences (NCATS), NIH, through the Clinical and Translational Science Awards Program (CTSA), a trademark of the Department of Health and Human Services, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.”
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Abstract

Objective To develop and externally validate a prediction model to calculate the likelihood of prolonged induction of labor (induction start to delivery time > 36 hours).

Study Design This was a retrospective cohort study of all nulliparous women with singleton pregnancies and vertex presentation at term who underwent induction of labor and had a vaginal delivery at a single academic center. Women with contraindications for vaginal delivery were excluded. Analyses were limited to women with unfavorable cervix (both simplified Bishop score [dilation, station, and effacement: range 0–9] <6 and cervical dilation <3 cm). Prolonged induction of labor was defined as the duration of induction (induction start time to delivery) longer than 36 hours. A backward stepwise logistic regression analysis was used to identify the factors associated with prolonged induction of labor by considering maternal characteristics and comorbidities as well as fetal conditions. The final model was validated using an external dataset of the Consortium on Safe Labor after applying the same inclusion and exclusion criteria. We developed a receiver observer characteristic curve with area under the curve (AUC) in validation cohorts.

Results Of 2,118 women, 364 (17%) had prolonged induction of labor. Factors associated with prolonged induction of labor included body mass index at admission, hypertension, fetal conditions, and epidural. Factors including younger maternal age, prelabor rupture of membranes, and a more favorable simplified Bishop score were associated with a decreased likelihood of prolonged induction of labor. In the external validation cohort, 4,418 women were analyzed, of whom 188 (4%) had prolonged induction of labor. The AUC of the final model was 0.76 (95% confidence interval: 0.73–0.80) for the external validation cohort. The online calculator was created and is available at: https://medstarapps.org/obstetricriskcalculator.

Conclusion Our externally validated model was efficient in predicting prolonged induction of labor with an unfavorable cervix.

Key Points

  • The number of inductions of labor at 39 weeks' gestation and beyond has been increasing.

  • Our model had a good prediction of prolonged induction of labor.

  • An online calculator has been created and available.

Keywords

Consortium on Safe Labor - external validation - labor induction - term pregnancy - unfavorable cervix

Note

This study was presented as a poster presentation at the Society for Maternal-Fetal Medicine 42nd Annual Pregnancy Meeting (January 31–February 5, 2022).


Supplementary Material



Publikationsverlauf

Eingereicht: 01. Dezember 2022

Angenommen: 18. Oktober 2023

Accepted Manuscript online:
20. Oktober 2023

Artikel online veröffentlicht:
23. November 2023

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