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External Cephalic Version: Is it an Effective and Safe Procedure?
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Defining failed induction of labor.

William A Grobman1, Jennifer Bailit2, Yinglei Lai3

  • 1Departments of Obstetrics and Gynecology of Northwestern University, Chicago, IL.

American Journal of Obstetrics and Gynecology
|November 16, 2017
PubMed
Summary
This summary is machine-generated.

A failed labor induction is not clearly defined. This study found that while maternal risks increase with longer latent phases, most women reach active labor by 15 hours, suggesting a minimum duration before considering cesarean delivery.

Keywords:
labor inductionlatent phaseoutcomes

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Labor and Delivery

Background:

  • The definition of a
  • failed
  • labor induction remains unclear, unlike standards for arrested active-phase labor.
  • Diagnosing failed induction often relies on latent phase duration, but a standard minimum duration is lacking.

Purpose of the Study:

  • To determine the frequency of adverse maternal and perinatal outcomes based on latent phase duration in nulliparous women undergoing labor induction.

Main Methods:

  • Analysis of an obstetric cohort (2008-2011) of 10,677 nulliparous women with term singleton gestations in cephalic presentation undergoing labor induction.
  • Latent phase defined from cervical ripening completion, oxytocin initiation, and membrane rupture until 5-cm dilation.
  • Compered cesarean delivery rates, maternal morbidities (postpartum hemorrhage, chorioamnionitis), and perinatal outcomes against latent phase duration.

Main Results:

  • The majority (96.4%) of women reached the active phase by 15 hours.
  • Cesarean delivery rates significantly increased with longer latent phase durations (P < .001).
  • Maternal morbidities like postpartum hemorrhage and chorioamnionitis also increased with longer latent phases (P < .001), while perinatal outcomes remained stable.

Conclusions:

  • Most women undergoing labor induction enter the active phase by 15 hours.
  • Maternal adverse outcomes increase with prolonged latent phase, though the absolute increase is small.
  • Cesarean delivery should not be performed before 15 hours of latent phase; decisions beyond this should be individualized based on labor progress.