Induction of Labor Quality Improvement Initiative
Project Aim
The Induction of Labor Quality Improvement Initiative sought to reduce failed induction of labor (IOL), and to improve the overall process surrounding IOL. More specifically, this project aimed to help participating hospitals improve the overall process surrounding IOL, and ultimately, reduce primary cesarean delivery.
Final Report
The goal of the project was to implement a standardized IOL algorithm in participating hospitals in Texas with the ultimate goal of reducing primary CD. Overall there was no change in primary CD rate, which was a distant proxy measure for failed induction. Lessons learned from this work, particularly the critical need to obtain physician and nurse buy-in from the outset, has helped inform the design of other inititiaves such as the maternal early warning system QI project. Read the full report.
Elements of the IOL Protocol
Non-medically indicated IOL should not be scheduled until ≥39 0/7 weeks of gestation and favorable cervix
IOL involves the following steps:
Cervical ripening for unfavorable cervix
If cervix is favorable, administer oxytocin per protocol
Perform amniotomy within 24 hours of starting oxytocin
Titrate oxytocin to achieve adequate contractions with the assistance of an intrauterine pressure catheter
Administer oxytocin for at least 12-18 hours after membrane rupture before diagnosing failed IOL
Once cervix is 4cm dilated and 90% effaced, or cervix is 5cm dilated (regardless of effacement), continue labor (may take up to 10 hours to dilate from 4cm to 6cm)
Once cervix reaches 6cm dilation, continue 2nd stage of labor following current guidelines
Subcommittee
Project Lead
Divya Patel, PhD, University of Texas Health Science Center at Tyler, Affiliate of The University of Texas System
Chairs
Christina Davidson, MD, Baylor College of Medicine
Carla Ortique, MD, Texas Children's Hospital