Does enhanced "bundling" criteria improve outcomes? A comparative study of elective inductions.
OBJECTIVE
To assess outcomes and costs of dyads achieving elective induction bundle criteria with a favorable Bishop score.


METHODS
In a historical automated records-based cohort study, 180 dyads undergoing elective induction bundling at a single institution from 2009 to 2010 were compared to a pre-introduction of bundling cohort. The bundled cohort was then compared by Bishop score.


RESULTS
The bundled cohort (n = 180) had a lower cesarean delivery rate (12% vs. 21%, p = 0.01), but neonatal special or intensive care admissions were not statistically significant compared to the pre-introduction of bundling cohort (n = 473). Ninety-six percent (n = 173) of the bundled cohort achieved bundle criteria. Those with a Bishop score > 6 (52%, n = 90) had fewer cesarean deliveries (4% vs. 19%, p = 0.003), fewer neonatal special or intensive care admissions (1% vs. 10%, p = 0.015), shorter induction time to vaginal delivery (8.8 vs. 17 hrs, p < 0.001), fewer cesareans for dystocia (75% vs. 94%, p = 0.002) or fetal heart rate abnormalities (25% vs. 50%, p = 0.015), and had one-sixth the average net income lost ($423 vs. $2,600, p < 0.001) compared to bundle achievers with a Bishop score of < or = 6.


CONCLUSIONS
The elective induction bundle does not guarantee quality and should require favorable cervix instead of documented Bishop score to proceed with induction.
Department of Obstetrics and Gynecology, Summa Akron City Hospital, 525 East Market, Medical II, P.O. Box 2090, Akron, OH 44309, USA.
Tiffany H
TH
Kenny
Jacqueline M
JM
Nicodemo
Bradford W
BW
Fenton
Vivian E
VE
von Gruenigen
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D036861:Delivery, Obstetric / Q000379:methods; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007747:Labor Stage, First / Q000502:physiology; D007751:Labor, Induced / Q000191:economics / Q000379:methods*; D010120:Oxytocics / Q000008:administration & dosage; D011247:Pregnancy; D016896:Treatment Outcome
D010120:Oxytocics