Evaluating the impact of a standardized induction protocol to reduce adverse perinatal outcomes: a prospective cohort study

Abstract

Objective

Our objective was to evaluate the impact of a standardized induction protocol on reducing maternal and neonatal morbidity in women undergoing an induction with an unfavorable cervix.

Study Design

We performed a prospective cohort study of women undergoing an induction from May 2013 to June 2015. Women who were ≥18 years, ≥37 weeks with intact membranes and an unfavorable cervix (Bishop score of ≤6 and cervical dilation ≤2 cm) with no prior cesarean were included. We compared the following outcomes between women managed with the labor protocol versus women in an observation group, managed at the discretion of the provider: Labor length, cesarean delivery, maternal and neonatal morbidity, and neonatal intensive care unit admission for >48 hours. Multivariable models incorporated confounders specific to each outcome.

Results

855 women were included (491: labor protocol group; 364: observational group). Women in the labor protocol group had a shorter time to delivery (15.7 hours vs. 18.0 hours, p < .001), a decrease in maternal morbidity (7.3% vs. 11.5%, p = .04), lower rates of NICU admission >48 hours (3.5% vs 8%, p = .005), and a lower neonatal morbidity (3.0% vs. 7.7%, p = .003) compared to women in the observational group. There was no difference in rate of cesarean between the labor protocol and observational groups (27.7% vs. 32.7%, p = .13). When adjusting for confounders, women in the labor protocol group had a 60% reduction in NICU admission >48 hours (RR: 0.41, 95% CI: 0.22-0.76) and a 70% reduction in neonatal morbidity (RR: 0.31, 95% CI: 0.13-0.70). Time to delivery and maternal morbidity were not significantly different in adjusted models.

Conclusion

Utilization of a standardized induction protocol was associated with a significant reduction in neonatal morbidity without increasing the risk of cesarean or maternal morbidity.

Keywords:

• Active management
• cesarean delivery
• induction of labor protocol
• maternal morbidity
• neonatal morbidity

Disclosure statement

L.D.L provided consultant work for Sudler and Hennessey on labor induction which is unrelated to this work. This was presented as a poster at the Annual Meeting for the Society of Maternal Fetal Medicine in Las Vegas, Nevada, USA in January 2017.

Additional information

Funding

This study was funded in part by a career development award in Women’s Reproductive Health Research: K12-HD001265-15.