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Am J Perinatol 2024; 41(16): 2222-2228
DOI: 10.1055/a-2302-7334
Original Article

Implementation and Clinical Impact of a Guideline for Standardized, Evidence-Based Induction of Labor

Jourdan E. Triebwasser
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
LeAnn Louis
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Joanne M. Bailey
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Leah Mitchell-Solomon
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Anita M. Malone
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Rebecca F. Hamm 
2   Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Michelle H. Moniz
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Molly J. Stout
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Funding None.
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Abstract

Objective This study aimed 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 preimplementation (PRE; November 1, 2021 through January 31, 2022) to postimplementation (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 h, p = 0.003), with faster time to delivery (adjusted hazard ratio [aHR] = 1.38, 95% CI: 1.15–1.66), more birthing people delivered within 24 hours (57 vs. 68.8%, adjusted odds ratio [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 = 0.009), vaginal misoprostol (34.5 vs. 68.3%, p < 0.001), and early amniotomy (19.1 vs. 31.7%, p = 0.001) 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.

Key Points

  • Implementation of an IOL guideline is associated with faster time to delivery.

  • Evidence-based induction practices were used more often after guideline implementation.

  • Adoption of evidence-based induction practices is variable even with a guideline.

Keywords

induction of labor - evidence-based practices - guideline - implementation - combined agent ripening - misoprostol - early amniotomy

Note

This study was presented in part as two poster abstracts at the Society for Maternal-Fetal Medicine 44th Annual Meeting in National Harbor, MD, February 10–14, 2024.




Publication History

Received: 12 March 2024

Accepted: 24 March 2024

Accepted Manuscript online:
09 April 2024

Article published online:
09 May 2024

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