Failed labor induction: Toward an objective diagnosis

Dwight J. Rouse, Steven J. Weiner, Steven L. Bloom, Michael W. Varner, Catherine Y. Spong, Susan M. Ramin, Steve N. Caritis, William A. Grobman, Yoram Sorokin, Anthony Sciscione, Marshall W. Carpenter, Brian M. Mercer, John M. Thorp, Fergal D. Malone, Margaret Harper, Jay D. Iams, Garland D. Anderson

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

To evaluate maternal and perinatal outcomes in women undergoing labor induction with an unfavorable cervix according to duration of oxytocin administration in the latent phase of labor after ruptured membranes. This was a secondary analysis of a randomized multicenter trial in which all cervical examinations from admission were recorded. Inclusion criteria: nulliparas at or beyond 36 weeks of gestation undergoing induction with a cervix of 2 cm or less dilated and less than completely effaced. The latent phase of labor was defined as ending at a cervical dilation of 4 cm and effacement of at least 90%, or at a cervical dilation of 5 cm regardless of effacement. A total of 1,347 women were analyzed. The overall vaginal delivery rate was 63.2%. Most women had exited the latent phase after 6 hours of oxytocin and membrane rupture (n=939; 69.7%); only 5% remained in the latent phase after 12 hours. The longer the latent phase, the lower the vaginal delivery rate. Even so, 39.4% of the 71 women who remained in the latent phase after 12 hours of oxytocin and membrane rupture were delivered vaginally. Chorioamnionitis, endometritis, or both, and uterine atony were the only maternal adverse outcomes related to latent-phase duration: adjusted odds ratios (95% confidence intervals) of 1.12 (1.07, 1.17) and 1.13 (1.06, 1.19), respectively, for each additional hour. Neonatal outcomes were not related to latent-phase duration. Almost 40% of the women who remained in the latent phase after 12 hours of oxytocin and membrane rupture were delivered vaginally. Therefore, it is reasonable to avoid deeming labor induction a failure in the latent phase until oxytocin has been administered for at least 12 hours after membrane rupture. III.

Original languageEnglish (US)
Pages (from-to)267-272
Number of pages6
JournalObstetrics and gynecology
Volume117
Issue number2
DOIs
StatePublished - Feb 2011

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Rouse, D. J., Weiner, S. J., Bloom, S. L., Varner, M. W., Spong, C. Y., Ramin, S. M., Caritis, S. N., Grobman, W. A., Sorokin, Y., Sciscione, A., Carpenter, M. W., Mercer, B. M., Thorp, J. M., Malone, F. D., Harper, M., Iams, J. D., & Anderson, G. D. (2011). Failed labor induction: Toward an objective diagnosis. Obstetrics and gynecology, 117(2), 267-272. https://doi.org/10.1097/AOG.0b013e318207887a