Implementation and clinical impact of a guideline for standardized, evidence-based induction of labor

Jourdan E Triebwasser; LeAnn Louis; Joanne M Bailey; Leah Mitchell-Solomon; Anita M Malone; Rebecca F Hamm; Michelle H Moniz; Molly J Stout

doi:10.1055/a-2302-7334

Implementation and clinical impact of a guideline for standardized, evidence-based induction of labor

Am J Perinatol. 2024 Apr 9. doi: 10.1055/a-2302-7334. Online ahead of print.

Authors

Jourdan E Triebwasser¹, LeAnn Louis¹, Joanne M Bailey¹, Leah Mitchell-Solomon¹, Anita M Malone¹, Rebecca F Hamm², Michelle H Moniz¹, Molly J Stout³

Affiliations

¹ Obstetrics and Gynecology, University of Michigan, Ann Arbor, United States.
² University of Pennsylvania Perelman School of Medicine, Philadelphia, United States.
³ University of Michigan Michigan Medicine, Ann Arbor, United States.

PMID: 38593985
DOI: 10.1055/a-2302-7334

Abstract

Objective: To assess the impact of implementation of an induction of labor (IOL) guideline on IOL length and utilization of evidence-based practices.

Study design: We conducted a quality improvement project to increase utilization of three evidence-based IOL practices: combined agent ripening, vaginal misoprostol, and early amniotomy. Singletons with intact membranes and cervical dilation ≤2 cm admitted for IOL were included. Primary outcome was IOL length. Secondary outcomes included cesarean delivery and practice utilization. We compared pre-implementation (PRE; November 1, 2021 through January 31, 2022) to post-implementation (POST; March 1, 2022 through April 30, 2022) with sensitivity analyses by self-reported race and ethnicity. Cox proportional hazards models and logistic regression were used to test the association between period and outcomes.

Results: Among 495 birthing people (PRE, n=293, POST, n=202), IOL length was shorter POST (22.0 vs. 18.3 hours, P=.003), with faster time to delivery (aHR 1.38, 95% CI 1.15-1.66), more birthing people delivered within 24 hours (57% vs. 68.8%, aOR 1.90 [95% CI 1.25-2.89]), and no difference in cesarean. Utilization of combined agent ripening (31.1% vs. 42.6%, P=.009); vaginal misoprostol (34.5% vs. 68.3%, P<.001); and early amniotomy (19.1% vs. 31.7%, P=.001) increased POST.

Conclusion: Implementation of an evidence-based IOL guideline is associated with shorter induction time. Additional implementation efforts to increase adoption of practices are needed to optimize outcomes after IOL.