Defining failed induction of labor - 04/01/18

Doi : 10.1016/j.ajog.2017.11.556

William A. Grobman, MD, MBA ^a,^⁎ , Jennifer Bailit, MD, MPH ^b, Yinglei Lai, PhD ^c, Uma M. Reddy, MD, MPH ^d, Ronald J. Wapner, MD ^e, Michael W. Varner, MD ^f, John M. Thorp, MD ^g, Kenneth J. Leveno, MD ^h, Steve N. Caritis, MD ⁱ, Mona Prasad, DO ^j, Alan T.N. Tita, MD, PhD ^k, George Saade, MD ^l, Yoram Sorokin, MD ^m, Dwight J. Rouse, MD ⁿ, Sean C. Blackwell, MD ^o, Jorge E. Tolosa, MD, MSCE ^p
for the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
G. Mallett, M. Ramos-Brinson, A. Roy, L. Stein, P. Campbell, C. Collins, N. Jackson, M. Dinsmoor, J. Senka, K. Paychek, A. Peaceman, M. Talucci, M. Zylfijaj, Z. Reid, R. Leed, J. Benson, S. Forester, C. Kitto, S. Davis, M. Falk, C. Perez, K. Hill, A. Sowles, J. Postma, S. Alexander, G. Andersen, V. Scott, V. Morby, K. Jolley, J. Miller, B. Berg, K. Dorman, J. Mitchell, E. Kaluta, K. Clark, K. Spicer, S. Timlin, K. Wilson, L. Moseley, M. Santillan, J. Price, K. Buentipo, V. Bludau, T. Thomas, L. Fay, C. Melton, J. Kingsbery, R. Benezue, H. Simhan, M. Bickus, D. Fischer, T. Kamon, D. DeAngelis, B. Mercer, C. Milluzzi, W. Dalton, T. Dotson, P. McDonald, C. Brezine, A. McGrail, C. Latimer, L. Guzzo, F. Johnson, L. Gerwig, S. Fyffe, D. Loux, S. Frantz, D. Cline, S. Wylie, J. Iams, M. Wallace, A. Northen, J. Grant, C. Colquitt, D. Rouse, W. Andrews, J. Moss, A. Salazar, A. Acosta, G. Hankins, N. Hauff, L. Palmer, P. Lockhart, D. Driscoll, L. Wynn, C. Sudz, D. Dengate, C. Girard, S. Field, P. Breault, F. Smith, N. Annunziata, D. Allard, J. Silva, M. Gamage, J. Hunt, J. Tillinghast, N. Corcoran, M. Jimenez, F. Ortiz, P. Givens, B. Rech, C. Moran, M. Hutchinson, Z. Spears, C. Carreno, B. Heaps, G. Zamora, J. Seguin, M. Rincon, J. Snyder, C. Farrar, E. Lairson, C. Bonino, W. Smith, K. Beach, S. Van Dyke, S. Butcher, E. Thom, M. Rice, Y. Zhao, P. McGee, V. Momirova, R. Palugod, B. Reamer, M. Larsen, C. Spong, S. Tolivaisa, J.P. Van Dorsten

^a Departments of Obstetrics and Gynecology of Northwestern University, Chicago, IL
^b MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH
^c George Washington University Biostatistics Center, Washington, DC
^d Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
^e Columbia University, New York, NY
^f University of Utah Health Sciences Center, Salt Lake City, UT
^g University of North Carolina at Chapel Hill, Chapel Hill, NC
^h University of Texas Southwestern Medical Center, Dallas, TX
ⁱ University of Pittsburgh, Pittsburgh, PA
^j Ohio State University, Columbus, OH
^k University of Alabama at Birmingham, Birmingham, AL
^l University of Texas Medical Branch, Galveston, TX
^m Wayne State University, Detroit, MI
ⁿ Brown University, Providence, RI
^o University of Texas Health Science Center at Houston-Children’s Memorial Hermann Hospital, Houston, TX
^p Oregon Health and Science University, Portland, OR

^∗Corresponding author: William A. Grobman, MD, MBA.

Abstract

Background

While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a “failed” induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal indications for cesarean delivery, remains lacking.

Objective

The objective of this study was to determine the frequency of adverse maternal and perinatal outcomes as a function of the duration of the latent phase among nulliparous women undergoing labor induction.

Study Design

This study is based on data from an obstetric cohort of women delivering at 25 US hospitals from 2008 through 2011. Nulliparous women who had a term singleton gestation in the cephalic presentation were eligible for this analysis if they underwent a labor induction. Consistent with prior studies, the latent phase was determined to begin once cervical ripening had ended, oxytocin was initiated, and rupture of membranes had occurred, and was determined to end once 5-cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (eg, postpartum hemorrhage, chorioamnionitis) and perinatal (eg, a composite frequency of seizures, sepsis, bone or nerve injury, encephalopathy, or death) outcomes, were compared as a function of the duration of the latent phase (analyzed with time both as a continuous measure and categorized in 3-hour increments).

Results

A total of 10,677 women were available for analysis. In the vast majority (96.4%) of women, the active phase had been reached by 15 hours. The longer the duration of a woman’s latent phase, the greater her chance of ultimately undergoing a cesarean delivery (P < .001, for time both as a continuous and categorical independent variable), although >40% of women whose latent phase lasted ≥18 hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < .001) and chorioamnionitis (P < .001), increased in frequency as the length of latent phase increased. Conversely, the frequencies of most adverse perinatal outcomes were statistically stable over time.

Conclusion

The large majority of women undergoing labor induction will have entered the active phase by 15 hours after oxytocin has started and rupture of membranes has occurred. Maternal adverse outcomes become statistically more frequent with greater time in the latent phase, although the absolute increase in frequency is relatively small. These data suggest that cesarean delivery should not be undertaken during the latent phase prior to at least 15 hours after oxytocin and rupture of membranes have occurred. The decision to continue labor beyond this point should be individualized, and may take into account factors such as other evidence of labor progress.

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Key words : labor induction, latent phase, outcomes

Plan

Introduction

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Results

Comment

	The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118) and the National Center for Research Resources (UL1 RR024989; 5UL1 RR025764). Comments and views of the authors do not necessarily represent views of the National Institutes of Health.
	The authors report no conflict of interest.
	Cite this article as: Grobman WA, Bailit J, Lai Y, et al. Defining failed induction of labor. Am J Obstet Gynecol 2018;218:122.e1-8.

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Vol 218 - N° 1

P. 122.e1-122.e8 - janvier 2018 Retour au numéro

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Defining failed induction of labor - 04/01/18

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