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Am J Perinatol 2022; 39(15): 1622-1632
DOI: 10.1055/a-1877-8996
SMFM Fellowship Series Article

Novel Evidence-Based Labor Induction Algorithm Associated with Increased Vaginal Delivery within 24 Hours

Kfier Kuba 
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Fatima Estrada-Trejo
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Calvin Lambert
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Kavita Vani
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Ruth Eisenberg
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Lisa Nathan
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Peter Bernstein
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
Francine Hughes 
1   Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to assess whether concordance with our proposed labor induction algorithm is associated with an increased rate of vaginal delivery within 24 hours.

Study Design We conducted a retrospective review of 287 induction of labors (IOLs) at a single urban, tertiary, academic medical center which took place before we created an evidence-based IOL algorithm. We then compared the IOL course to the algorithm to assess for concordance and outcomes. Patients age 18 years or over with a singleton, cephalic pregnancy of 366/7 to 420/7 weeks' gestation were included. Patients were excluded with a Bishop's score >6, contraindication to misoprostol or cervical Foley catheter, major fetal anomalies, or intrauterine fetal death. Patients with 100% concordance were compared with <100% concordant patients, and patients with ≥80% concordance were compared with <80% concordant patients. Adjusted hazard ratios (AHRs) were calculated for rate of vaginal delivery within 24 hours, our primary outcome. Competing risk's analysis was conducted for concordant versus nonconcordant groups, using vaginal delivery as the outcome of interest, with cesarean delivery (CD) as a competing event.

Results Patients with 100% concordance were more likely to have a vaginal delivery within 24 hours, n = 66 of 77 or 85.7% versus n = 120 of 210 or 57.1% (p < 0.0001), with an AHR of 2.72 (1.98, 3.75, p < 0.0001) after adjusting for delivery indication and scheduled status. Patients with 100% concordance also had shorter time from first intervention to delivery (11.9 vs. 19.4 hours). Patients with ≥80% concordance had a lower rate of CD (11/96, 11.5%) compared with those with <80% concordance (43/191 = 22.5%; p = 0.0238). There were no differences in neonatal outcomes assessed.

Conclusion Our IOL algorithm may offer an opportunity to standardize care, improve the rate of vaginal delivery within 24 hours, shorten time to delivery, and reduce the CD rate for patients undergoing IOL.

Key Points

  • Studies on IOL have focused on individual steps. A labor induction algorithm allows for standardization.

  • Algorithm concordance is associated with decreased time to delivery.

  • Algorithm concordance is associated with decreased CD rate.

Keywords

labor - induction - algorithm - induction of labor - misoprostol - Foley catheter - oxytocin - standardize

Note

This research was presented at the 41st Annual SMFM Pregnancy Meeting, held virtually January 24–30, 2021, as poster no.: 617.


Supplementary Material



Publication History

Received: 29 July 2021

Accepted: 03 June 2022

Accepted Manuscript online:
16 June 2022

Article published online:
22 August 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014; (155) 1-8
    PubMedGoogle Scholar
  • 2 ACOG Committee on Practice Bulletins–Obstetrics. ACOG practice bulletin no. 107: induction of labor. Obstet Gynecol 2009; 114 (2, pt. 1): 386-397
    CrossrefPubMedGoogle Scholar
  • 3 Grobman WA, Rice MM, Reddy UM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
    CrossrefPubMedGoogle Scholar
  • 4 Ghartey J, Macones GA. 39-week nulliparous inductions are not elective. Am J Obstet Gynecol 2020; 222 (06) 519-520
    CrossrefPubMedGoogle Scholar
  • 5 Molina RL, Gombolay M, Jonas J. et al. Association between labor and delivery unit census and delays in patient management: findings from a computer simulation module. Obstet Gynecol 2018; 131 (03) 545-552
    CrossrefPubMedGoogle Scholar
  • 6 Plough AC, Galvin G, Li Z. et al. Relationship between labor and delivery unit management practices and maternal outcomes. Obstet Gynecol 2017; 130 (02) 358-365
    CrossrefPubMedGoogle Scholar
  • 7 Committee on Gynecologic Practice. ACOG committee opinion no. 750: perioperative pathways: enhanced recovery after surgery. Obstet Gynecol 2018; 132 (03) e120-e130 [published correction appears in Obstet Gynecol. 2019 Jun;133(6):1288] [published correction appears in Obstet Gynecol. 2019 Nov;134(5):1121]
    CrossrefPubMedGoogle Scholar
  • 8 ACOG Practice Bulletin No. ACOG practice bulletin no. 211: critical care in pregnancy. Obstet Gynecol 2019; 133 (05) e303-e319
    CrossrefPubMedGoogle Scholar
  • 9 Clinical Guidelines and Standardization of Practice to Improve Outcomes. Clinical guidelines and standardization of practice to improve outcomes: ACOG committee opinion, number 792. Obstet Gynecol 2019; 134 (04) e122-e125
    CrossrefPubMedGoogle Scholar
  • 10 Goffman D, Nathan L, Chazotte C. Obstetric hemorrhage: a global review. Semin Perinatol 2016; 40 (02) 96-98
    CrossrefPubMedGoogle Scholar
  • 11 ACOG Committee Opinion No. ACOG committee opinion no. 767: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol 2019; 133 (02) e174-e180
    PubMedGoogle Scholar
  • 12 Quantitative Blood Loss in Obstetric Hemorrhage. ACOG committee opinion, number 794. Obstet Gynecol 2019; 134 (06) e150-e156
    CrossrefPubMedGoogle Scholar
  • 13 Committee on Practice Bulletins-Obstetrics. Practice bulletin no. 183: postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186
    Google Scholar
  • 14 Hamm RF, Srinivas SK, Levine LD. A standardized labor induction protocol: impact on racial disparities in obstetrical outcomes. Am J Obstet Gynecol MFM 2020; 2 (03) 100148
    CrossrefPubMedGoogle Scholar
  • 15 ACOG/SMFM Obstetric Care Consensus. Safe prevention of the primary cesarean delivery. Accessed July 1, 2022, at: https://asagio.org/wp-content/uploads/2018/12/educacion-medica/segundo-semestre-2018/acog-smfm.pdf
    PubMedGoogle Scholar
  • 16 Pimentel VM, Arabkhazaeli M, Moon JY. et al. Induction of labor using one dose vs multiple doses of misoprostol: a randomized controlled trial. Am J Obstet Gynecol 2018; 218 (06) 614.e1-614.e8
    CrossrefPubMedGoogle Scholar
  • 17 Levine LD, Downes KL, Elovitz MA, Parry S, Sammel MD, Srinivas SK. Mechanical and pharmacologic methods of labor induction: a randomized controlled trial. Obstet Gynecol 2016; 128 (06) 1357-1364
    CrossrefPubMedGoogle Scholar
  • 18 Battarbee AN, Palatnik A, Peress DA, Grobman WA. Association of early amniotomy after Foley balloon catheter ripening and duration of nulliparous labor induction. Obstet Gynecol 2016; 128 (03) 592-597
    CrossrefPubMedGoogle Scholar
  • 19 De Vivo V, Carbone L, Saccone G. et al. Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2020; 222 (04) 320-329
    CrossrefPubMedGoogle Scholar
  • 20 Cahill AG, Srinivas SK, Tita ATN. et al. Effect of immediate vs delayed pushing on rates of spontaneous vaginal delivery among nulliparous women receiving neuraxial analgesia: a randomized clinical trial. JAMA 2018; 320 (14) 1444-1454
    CrossrefPubMedGoogle Scholar
  • 21 Suresh SC, Kucirka L, Chau DB, Hadley M, Sheffield JS. Evidence-based protocol decreases time to vaginal delivery in elective inductions. Am J Obstet Gynecol MFM 2021; 3 (01) 100294
    CrossrefPubMedGoogle Scholar
  • 22 Goff SL, Knee A, Morello M, Grow D, Bsat F. Handoff quality for obstetrical inpatients varies depending on time of day and provider type. J Reprod Med 2014; 59 (3,4): 95-102
    PubMedGoogle Scholar
  • 23 Deering S, Johnston LC, Colacchio K. Multidisciplinary teamwork and communication training. Semin Perinatol 2011; 35 (02) 89-96
    CrossrefPubMedGoogle Scholar
  • 24 Schoen CN, Saccone G, Backley S. et al. Increased single-balloon Foley catheter volume for induction of labor and time to delivery: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97 (09) 1051-1060
    CrossrefPubMedGoogle Scholar
  • 25 Ayala NK, Rouse DJ. Nondefinitive Studies of Labor Induction Methods: Enough Already!. Obstet Gynecol 2019; 134 (01) 7-9
    CrossrefPubMedGoogle Scholar
  • 26 How HY, Leaseburge L, Khoury JC, Siddiqi TA, Spinnato JA, Sibai BM. A comparison of various routes and dosages of misoprostol for cervical ripening and the induction of labor. Am J Obstet Gynecol 2001; 185 (04) 911-915
    CrossrefPubMedGoogle Scholar
  • 27 Mackeen AD, Durie DE, Lin M. et al. Foley plus oxytocin compared with oxytocin for induction after membrane rupture: a randomized controlled trial. Obstet Gynecol 2018; 131 (01) 4-11
    CrossrefPubMedGoogle Scholar
  • 28 Battarbee AN. Maternal and neonatal outcomes associated with early amniotomy in term nulliparous labor induction. Am J Obstet Gynecol 2019; 220: 1
    CrossrefPubMedGoogle Scholar
  • 29 Macones GA, Cahill A, Stamilio DM, Odibo AO. The efficacy of early amniotomy in nulliparous labor induction: a randomized controlled trial. Am J Obstet Gynecol 2012; 207 (05) 403 e1-403 e5
    CrossrefPubMedGoogle Scholar
  • 30 Wei S, Wo BL, Qi HP. et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2013; (08) CD006794
    PubMedGoogle Scholar
  • 31 Levine LD. Cervical ripening: why we do what we do. Semin Perinatol 2020; 44 (02) 151216
    CrossrefPubMedGoogle Scholar
  • 32 Gu N, Ru T, Wang Z. et al. Foley catheter for induction of labor at term: an open-label, randomized controlled trial. PLoS One 2015; 10 (08) e0136856
    CrossrefPubMedGoogle Scholar
  • 33 Battarbee AN, Sandoval G, Grobman WA. et al; Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network. Maternal and neonatal outcomes associated with early amniotomy in term nulliparous labor induction. Obstet Gynecol 2021; 38 (S 01): e239-e248
    PubMedGoogle Scholar
  • 34 Yee LM, Sandoval G, Bailit J. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Maternal and neonatal outcomes with early compared with delayed pushing among nulliparous women. Obstet Gynecol 2016; 128 (05) 1039-1047
    CrossrefPubMedGoogle Scholar
  • 35 Freret TS, Chacón KM, Bryant AS, Kaimal AJ, Clapp MA. Oxytocin compared to buccal misoprostol for induction of labor after term prelabor rupture of membranes. Am J Perinatol 2021; 38 (03) 224-230
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Lim G, Facco FL, Nathan N, Waters JH, Wong CA, Eltzschig HK. A review of the impact of obstetric anesthesia on maternal and neonatal outcomes. Anesthesiology 2018; 129 (01) 192-215
    CrossrefPubMedGoogle Scholar
  • 37 Salim R, Schwartz N, Zafran N, Zuarez-Easton S, Garmi G, Romano S. Comparison of single- and double-balloon catheters for labor induction: a systematic review and meta-analysis of randomized controlled trials. J Perinatol 2018; 38 (03) 217-225
    CrossrefPubMedGoogle Scholar
  • 38 Yang F, Huang S, Long Y, Huang L. Double-balloon versus single-balloon catheter for cervical ripening and labor induction: a systematic review and meta-analysis. J Obstet Gynaecol Res 2018; 44 (01) 27-34
    CrossrefPubMedGoogle Scholar