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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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