Evidence-based protocol decreases time to vaginal delivery in elective inductions

Suresh, Sunitha C.; Kucirka, Lauren M.; Chau, Danielle; Hadley, Megan; Sheffield, Jeanne S.

doi:10.1016/j.ajogmf.2020.100294

Cited by 9 publications

(15 citation statements)

References 15 publications

(9 reference statements)

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“…and found an overall reduction in time to delivery of 1.5 hours [38]. However, our studies have significant differences, not limited to their design.…”

Section: Suresh Et Al Recently Reported On the Effects Of Implementin...contrasting

confidence: 52%

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

et al. 2022

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Objective: 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 IOLs at a single urban, tertiary, academic medical center which took place before we created an evidence-based induction of labor (IOL) algorithm. We then compared the IOL course to the algorithm to assess for concordance and outcomes. Patients age 18 or over with a singleton, cephalic pregnancy of 36 6/7 to 42 0/7 weeks’ gestation were included. Patients were excluded with a Bishop score >6, contraindication to misoprostol or cervical Foley catheter, major fetal anomalies or intrauterine fetal death. Patients with 100% concordance were compared to <100% concordant patients, and patients with 80% concordance were compared to <80% concordant patients. Adjusted hazard ratios (AHRs) were calculated for rate of vaginal delivery within 24 hours, our primary outcome. Competing risks analysis was conducted for concordant vs. non-concordant groups, using vaginal delivery as the outcome of interest, with cesarean delivery as a competing event. Results: Patients with 100% concordance were more likely to have a vaginal delivery within 24 hours, n = 66/77 or 85.7% vs. n = 120/210 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 cesarean delivery (11/96, 11.5%) compared to 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 cesarean delivery rate for patients undergoing IOL.

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“…and found an overall reduction in time to delivery of 1.5 hours [38]. However, our studies have significant differences, not limited to their design.…”

Section: Suresh Et Al Recently Reported On the Effects Of Implementin...contrasting

confidence: 52%

“…Suresh et al recently reported on the effects of implementing a standardized protocol for IOL and found an overall reduction in time to delivery of 1.5 hours. 21 However, our studies have significant differences, not limited to their design. First, our IOL algorithms are different.…”

Section: Resultsmentioning

confidence: 86%

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

et al. 2022

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“…Our findings are similar to a previous study of standardizing IOL within a single academic institution, in which time to delivery was reduced overall and among elective IOL without changes in cesarean birth or maternal morbidity. 21 The This article is protected by copyright. All rights reserved.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Clinical Impact of a Guideline for Standardized, Evidence-Based Induction of Labor

Triebwasser,

Louis,

Bailey

et al. 2024

Am J Perinatol

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Objective: To assess the impact of implementation of an induction of labor (IOL) guideline on IOL length and utilization of evidence-based practices. Study Design: We conducted a quality improvement project to increase utilization of three evidence-based IOL practices: combined agent ripening, vaginal misoprostol, and early amniotomy. Singletons with intact membranes and cervical dilation ≤2 cm admitted for IOL were included. Primary outcome was IOL length. Secondary outcomes included cesarean delivery and practice utilization. We compared pre-implementation (PRE; November 1, 2021 through January 31, 2022) to post-implementation (POST; March 1, 2022 through April 30, 2022) with sensitivity analyses by self-reported race and ethnicity. Cox proportional hazards models and logistic regression were used to test the association between period and outcomes. Results: Among 495 birthing people (PRE, n=293, POST, n=202), IOL length was shorter POST (22.0 vs. 18.3 hours, P=.003), with faster time to delivery (aHR 1.38, 95% CI 1.15-1.66), more birthing people delivered within 24 hours (57% vs. 68.8%, aOR 1.90 [95% CI 1.25-2.89]), and no difference in cesarean. Utilization of combined agent ripening (31.1% vs. 42.6%, P=.009); vaginal misoprostol (34.5% vs. 68.3%, P<.001); and early amniotomy (19.1% vs. 31.7%, P=.001) increased POST. Conclusion: Implementation of an evidence-based IOL guideline is associated with shorter induction time. Additional implementation efforts to increase adoption of practices are needed to optimize outcomes after IOL.

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“…One study found an association between implementation of an evidence-based protocol, consisting of standardized protocols for cervical ripening, early amniotomy, and staff education, and decreased time to birth, without an increase in adverse perinatal outcomes. 22 Increasing access to outpatient cervical ripening methods also has the potential to reduce resource use through decreasing the amount of time patients spend in the hospital. A systematic review and meta-analysis found no substantial difference in the rate of cesarean births among low-risk pregnancies when outpatient single-balloon catheters or dinoprostone were used.…”

Section: Discussionmentioning

confidence: 99%

“…One such strategy to manage the increase in non–medically indicated induction of labor is to use evidence-based techniques that can reduce overall admission time. One study found an association between implementation of an evidence-based protocol, consisting of standardized protocols for cervical ripening, early amniotomy, and staff education, and decreased time to birth, without an increase in adverse perinatal outcomes . Increasing access to outpatient cervical ripening methods also has the potential to reduce resource use through decreasing the amount of time patients spend in the hospital.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non–Medically Indicated Induction of Labor at 39 Weeks

et al. 2023

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ImportanceNon–medically indicated induction of labor has been demonstrated to potentially improve some obstetric outcomes, such as decreasing cesarean birth. It has been reported that rates of cesarean birth and other obstetric outcomes vary among hospitals with different characteristics.ObjectiveTo assess whether obstetric outcomes differ between nulliparous individuals with low-risk pregnancies managed with non–medically indicated induction of labor compared with expectant management in different types of hospitals.Design, Setting, and ParticipantsThis retrospective cohort study included non–medically indicated induction of labor at 39 weeks' gestation compared with expectant management of singleton, nonanomalous, births in nulliparous women with low-risk pregnancies in California between January 1, 2007, and December 31, 2011. The initial analysis of these data was performed in 2021. Outcomes were assessed by 3 hospital characteristics: location (urban vs rural), obstetric volume, and teaching (academic vs community) status. Volume was categorized based on the average number of births per year and grouped into low (&lt;1200 births per year), medium (1200-2399 births per year), and high (≥2400 births per year). Births with previous or planned cesarean delivery were excluded, and non–medically indicated induction of labor was defined as induction of labor without a specific medical indication. Testing with χ2 and multivariable logistic regression analyses was used for statistical comparisons with a cutoff level of P = .01.ExposureNon–medically indicated induction of labor at 39 weeks’ gestation.Main Outcomes and MeasuresThe primary outcome was cesarean birth, and numerous secondary perinatal outcomes were also assessed.ResultsThere were 455 044 births included in this study. When stratified by hospital variables, a number of sociodemographic characteristics were significantly different, such as race and ethnicity, age, body mass index, and insurance type. The adjusted odds ratios (aORs) of cesarean birth were significantly lower in all settings with induction of labor except for low-volume hospitals, in which there was no significant difference (aOR, 0.95; 95% CI, 0.82-1.09). Chorioamnionitis and postpartum hemorrhage were lower with induction of labor among nearly every hospital when stratified by hospital characteristics. Neonatal outcomes were improved in all settings with induction of labor compared with expectant management.Conclusions and RelevanceThese findings suggest that non–medically indicated induction of labor may be associated with a lower rate of cesarean births and some maternal and neonatal adverse outcomes in a range of hospital settings.

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Evidence-based protocol decreases time to vaginal delivery in elective inductions

Cited by 9 publications

References 15 publications

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

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

Implementation and Clinical Impact of a Guideline for Standardized, Evidence-Based Induction of Labor

Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non–Medically Indicated Induction of Labor at 39 Weeks

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