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  • Failed Labor Induction
    Obstetrics & Gynecology, 2020
    Co-Authors: Dwight J. Rouse, Steven J. Weiner, Steven L. Bloom, Michael W. Varner, Catherine Y. Spong, Susan M. Ramin, Steve N. Caritis, William A. Grobman, Yoram Sorokin, Anthony Sciscione
    Abstract:

    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.\ud \ud METHODS: This was a secondary analysis of a randomized multicenter trial in which all cervical examinations from admission were recorded. Inclusion criteria: 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.\ud \ud 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.\ud \ud CONCLUSION: 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.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.This was a secondary analysis of a randomized multicenter trial in which all cervical examinations from admission were recorded. Inclusion criteria: 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.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.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.III

  • maternal and neonatal outcomes associated with amniotomy among nulliparous women undergoing Labor Induction at term
    American Journal of Perinatology, 2020
    Co-Authors: Ashley N. Battarbee, Dwight J. Rouse, William A. Grobman, Uma M Reddy, Alan T N Tita, Robert M Silver, Yasser Y Elsayed, Grecio Sandoval, Ronald J Wapner, George R Saade
    Abstract:

    OBJECTIVE: The aim of the study is to evaluate the association between amniotomy at various time points during Labor Induction and maternal and neonatal outcomes among term, nulliparous women. STUDY DESIGN: Secondary analysis of a randomized trial of term Labor Induction versus expectant management in low-risk, nulliparous women (2014-2017) was conducted. Women met inclusion criteria if they underwent Induction >/=38 weeks' gestation using oxytocin with documented time and type of membrane rupture. Women with antepartum stillbirth or fetal anomaly were excluded. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal complications. Maternal and neonatal outcomes were compared among women with amniotomy versus women with intact membranes and no amniotomy at six 2-hour time intervals: before oxytocin initiation, 0 to /=4 hours after oxytocin was associated with lower odds of Labor duration >24 hours. Amniotomy at time intervals >/=2 hours and 3 days. Amniotomy was not associated with postpartum or neonatal complications. CONCLUSION: Among a contemporary cohort of nulliparous women undergoing term Labor Induction, amniotomy was associated with either lower or similar odds of cesarean delivery and other adverse outcomes, compared with no amniotomy.

  • Labor Induction versus expectant management in low risk nulliparous women
    The New England Journal of Medicine, 2018
    Co-Authors: William A. Grobman, Madeline Murguia Rice, Uma M Reddy, Alan T N Tita, Robert M Silver, G Mallett, Kim Hill, Elizabeth Thom, Yasser Y Elsayed, Annette Perezdelboy
    Abstract:

    Abstract Background The perinatal and maternal consequences of Induction of Labor at 39 weeks among low-risk nulliparous women are uncertain. Methods In this multicenter trial, we randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to Labor Induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal complications; the principal secondary outcome was cesarean delivery. Results A total of 3062 women were assigned to Labor Induction, and 3044 were assigned to expectant management. The primary outcome occurred in 4.3% of neonates in the Induction group and in 5.4% in the expectant-management group (relative risk, 0.80; 95% confidence interval [CI], 0.64 to 1.00). The frequency of cesarean delivery was significantly lower in the Induction group than in the expectant-management group (18.6% vs. 22.2%; relative risk, 0.84; 95% CI, 0.76 to 0.93). Conclusions Induction of l...

  • failed Labor Induction toward an objective diagnosis
    Obstetrics & Gynecology, 2011
    Co-Authors: Dwight J. Rouse, Steven J. Weiner, Steven L. Bloom, Michael W. Varner, Catherine Y. Spong, Susan M. Ramin, Steve N. Caritis, William A. Grobman, Yoram Sorokin, Anthony Sciscione
    Abstract:

    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