Year: 2020
Type: article
Study design: Observational Study
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. METHODS: This study is based on data from an obstetric cohort of women delivering at 25 U.S. hospitals from 2008-2011. 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 (ROM) had occurred, and was determined to end once 5 cm dilation was achieved. The frequencies of cesarean delivery, as well as of adverse maternal (e.g., cesarean delivery, postpartum hemorrhage, chorioamnionitis) and perinatal outcomes (e.g., a composite frequency of either seizures, sepsis, bone or nerve injury, encephalopathy, or death), 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<0.001, for time both as a continuous and categorical independent variable), although more than forty percent of women whose latent phase lasted for 18 or more hours still had a vaginal delivery. Several maternal morbidities, such as postpartum hemorrhage (P < 0.001) and chorioamnionitis (P < 0.001), 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.
DOI: 10.17615/wtjh-m364
Authors: Fay,, Berg,, McDonald,, Reamer,, Saade, George, Spears,, Latimer,, Clark,, Milluzzi,, Jimenez,, Acosta,, Falk,, Simhan,, Wynn,, Moss,, Timlin,, Kingsbery,, Thomas,, Snyder,, Silva,, Rincon,, Carreno,, Hutchinson,, Reid,, Kitto,, Van Dyke,, Paychek,, Gerwig,, Sowles,, McGee,, Breault,, Roy,, Zhao,, Wapner, Ronald J., Tillinghast,, Price,, Field,, Bludau,, Grobman, William A., Andersen,, Loux,, Beach,, Wylie,, Morby,, Perez,, Wallace,, Mallett,, Van Dorsten,, Girard,, Collins,, Prasad, Mona, Smith,, Rouse, Dwight J., Heaps,, Iams,, Larsen,, Benezue,, Thorp, John M., McGrail,, Dalton,, Annunziata,, Caritis, Steve N., Sorokin, Yoram, Lockhart,, Fischer,, Zylfijaj,, Salazar,, Momirova,, Palugod,, Kamon,, Lairson,, Grant,, Frantz,, Northen,, Varner, Michael W., Stein,, Blackwell, Sean C., Hill,, Lai, Yinglei, Moseley,, Jackson,, Spong,, Tolivaisa,, Colquitt,, Ortiz,, Talucci,, Postma,, Zamora,, Andrews,, Corcoran,, Rice,, Fyffe,, Forester,, Hunt,, Santillan,, Leveno, Kenneth J., Gamage,, Alexander,, Reddy, Uma M., Ramos-Brinson,, DeAngelis,, Leed,, Seguin,, Allard,, Smith,, Guzzo,, Moran,, Peaceman,, Buentipo,, Spicer,, Senka,, Campbell,, Tolosa, Jorge E., Bonino,, Davis,, Miller,, Driscoll,, Kaluta,, Melton,, Hankins,, Mitchell,, Sudz,, Rouse,, Bailit, Jennifer, Dorman,, Johnson,, Bickus,, Rech,, Scott,, Dotson,, Dengate,, Jolley,, Givens,, Butcher,, Wilson,, Brezine,, Benson,, Farrar,, Hauff,, Tita, Alan T.N., Cline,, Thom,, Mercer,, Palmer,, Dinsmoor,
Institution: University of North Carolina at Chapel Hill
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Kaiser Permanente, Brown University, Wayne State University, Ohio State University, Northwestern University, George Washington University, University of Pittsburgh, Case Western Reserve University, Drexel University, University of South Carolina, University of Texas Health Science Center at Houston, NorthShore University HealthSystem, University of North Carolina at Chapel Hill, National Institute of Child Health and Human Development, Eunice Kennedy Shriver National Institute of Child Health and Human Development
OpenAlex ID: W4301624333