Failed labor induction: toward an objective diagnosis.
OBJECTIVE
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.


METHODS
This was a secondary analysis of a randomized multicenter trial in which all cervical examinations from admission were recorded.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.


METHODS
III.
From the Department of Obstetrics and Gynecology at the University of Alabama at Birmingham, Birmingham, Alabama; University of Texas Southwestern Medical Center, Dallas, Texas; University of Utah, Salt Lake City, Utah; The University of Texas Health Science Center at Houston, Houston, Texas; University of Pittsburgh, Pittsburgh, Pennsylvania; Northwestern University, Chicago, Illinois; Wayne State University, Detroit, Michigan; Drexel University, Philadelphia, Pennsylvania; Brown University, Providence, Rhode Island; Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; University of North Carolina at Chapel Hill, Chapel Hill, NC; Columbia University, New York, NY; Wake Forest University Health Sciences, Winston-Salem, North Carolina; The Ohio State University, Columbus, Ohio; the University of Texas Medical Branch, Galveston, Texas; and The George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Dwight J
DJ
Rouse
Steven J
SJ
Weiner
Steven L
SL
Bloom
Michael W
MW
Varner
Catherine Y
CY
Spong
Susan M
SM
Ramin
Steve N
SN
Caritis
William A
WA
Grobman
Yoram
Y
Sorokin
Anthony
A
Sciscione
Marshall W
MW
Carpenter
Brian M
BM
Mercer
John M
JM
Thorp
Fergal D
FD
Malone
Margaret
M
Harper
Jay D
JD
Iams
Garland D
GD
Anderson
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D010120:Oxytocics / Q000008:administration & dosage*; D010121:Oxytocin / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
D010120:Oxytocics; D010121:Oxytocin
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