[Practice effect of bundled management strategies for induction of labor: a single-center historical controlled...

Objective: To investigate the impact of bundled management of late-pregnancy induction strategies on induction time and maternal and perinatal clinical outcomes. Methods: This was a historical control study, including 61 pregnant women before the implementation of the bundled management strategies for induction protocol in September 2024, and 78 pregnant women after the implementation in December 2024, who received regular prenatal check-ups and finally admitted to Peking University Third Hospital for elective induction of labor at term. The rate of successful induction, the rate of reaching active phase, induction to labor length, duration of labor, hospital stay, and adverse maternal and preinatal outcomes and other information were compared between two groups. Logistic regression model was used to analyze the factors affecting the rates of successful labor induction and reaching active phase. Kaplan-Meier survival curves were plotted for induction to labor length and duration of labor, and the Cox proportional hazards regression model was used to analyze the impact of the bundled management strategies for induction strategies on the above indicators. Results: (1) Compared with the group before implementation, the group after implementation had a shorter induction to labor length (median: 47.4 vs 35.1 h), a shorter duration of labor (median: 14.0 vs 10.5 h), and a shorter hospital stay (median: 6 vs 4 d). The rate of successful induction increased [87% (53/61) vs 97% (76/78)], and the rate of reaching active phase increased [70% (43/61) vs 86% (67/78)]; the differences were statistically significant (all P<0.05). (2) Multivariate logistic regression analysis showed that the implementation of the bundled management strategies promoted successful induction (OR=7.299, 95%CI: 1.189-44.800; P=0.032) and reaching active phase (OR=2.640, 95%CI: 1.003-6.951; P=0.049). A pre-pregnancy body mass index<18.5 kg/m² promoted successful induction (OR=9.142, 95%CI: 1.154-72.423; P=0.036). (3) Kaplan-Meier curve analysis indicated that compared with the group before the implementation, the group after the implementation had a significantly shorter induction to labor length (χ²=13.883, P<0.001) and a shorter duration of labor (χ²=5.72, P=0.017). Cox proportional hazards regression analysis showed that the implementation of the bundled management strategies for induction protocol was a protective factor for shortening induction to labor length (HR=1.806, 95%CI: 1.186-2.749; P=0.006) and duration of labor (HR=1.677, 95%CI: 1.066-2.637; P=0.025). A cervical Bishop score >3 at admission was a protective factor for shortening the induction to labor length (HR=1.627, 95%CI: 1.110-2.384; P=0.013), and parity was a protective factor for shortening the duration of labor (HR=3.370, 95%CI: 1.806-6.288; P<0.001). Conclusions: By the implementation of the bundled management strategies for induction protocol, it is possible to promote successful induction of labor and reaching the active phase for pregnant women undergoing induction. This approach also shortens induction to labor length and the duration of labor, without increasing the risk of maternal and perinatal complications.