Study: Predicting a failed induction

Predicting a failed induction - Australian and New Zealand Journal of Obstetrics and Gynaecology , vol 47, no 5, October 2007, pp 394-398 Beckmann M - (2007)

Background: A failed induction usually refers to failure to progress to the active phase of labour; however, there is no consensus regarding when an induction has failed.

Aims: To investigate the factors (particularly length of latent phase) that may influence mode of birth for women undergoing Syntocinon induction of labour. Methods: A retrospective analysis of 978 nulliparous women undergoing Syntocinon induction of labour following artificial or spontaneous rupture of membranes was performed.

Results: As the length of the latent phase increased, the likelihood of birth by caesarean section increased significantly (P < 0.001). After ten hours of Syntocinon administration, the 8% of women not in the active phase of labour had approximately a 75% chance of being delivered by emergency caesarean section and after 12 h the chance was almost 90%. Multivariate analysis also suggested an association between birth by caesarean section and use of prostaglandin gel (P < 0.001) or mechanical methods of cervical priming (P = 0.004), maternal height < 155 cm (P = 0.020) and cervical dilation prior to commencement of Syntocinon (P = 0.018).

Conclusions: It would seem reasonable to continue a Syntocinon infusion for at least ten hours in women undergoing induction who have yet to reach the active phase of labour (4 cm), and unclear benefit in continuing an induction beyond 12 h. The duration of latent phase is a helpful predictor of subsequent mode of birth.
(16 references) (Author)

If I understand this correctly, then I did pretty well to have a vaginal birth after my induction. I was given the syntocinon drip after my waters started leaking. My cervix was not ripe at all and I was not dialated at all. I didn't reach 4cm until after about 15hrs and bubs didn't make her arrival until 24hrs after the drip began. I was often threatened with a c/s by the dr, but was determined not to have one. He told me that he would do one if bubs was not here on his next check, but luckily she made it just in time.
I hope with my next pg I don't have to go through it again!

Brilliant Kelly! Does that mean, do you think, one could state when one was overdue enough to let them try induction "OK, i'll have the drip for 10 hours but if it doesn't work i'm going home again."?

I'm betting some "foetal distress" would be magicked out of the ether to warrant the following c-section. I know 3 women who had sections for "failture to progress" and one was already 4cm when the drip was put in and only given 3 hours (still at 4cm - BUT examined by a different midwife, making the whole thing very subjective and pointless) on the drip before the scalpel came out!

Bx

If they do say the baby is in distress.. can it be as simple as turning off the drip and letting the baby recover? or once a baby is in distress is it truly an emergency to get it out? Probably a silly question.. but hey.. doesn't hurt to ask :) Altho.. there's the meconium thing with a distressed bub isn't there.

I was about 3cm when I was augmented with the drip... and it took about 2 hours for them to start counting it as active labour. I think they counted it from the time I looked like I was in real labour.. before that I was smiling at the midwife whenever she came in.. so she figured it needed to be cranked up a notch! LOL.

Thankyou tho! Just another note I will take and discuss with my OB on Monday, coz a c/s is a big no no in my birth plan if at all possible! :) Am already preparing myself to put my foot down on how long he'll let me go without the drip if my waters break in early labour again. hehe. He's actually very good to talk to, but I'm finding out that if I don't specifically talk to him about something.. his 'standard' procedures aren't that top notch (if that makes sense). But if you tell him you want something.. he's very good about it. I'm learning this from other friends who have had him before too.

Bec, most hospitals want to keep you there once they have started something just in case something happens, so I don't see people being able to go home... again a case of failure to wait, not failure to progress is the problem in the first place.

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Does that mean, do you think, one could state when one was overdue enough to let them try induction "OK, i'll have the drip for 10 hours but if it doesn't work i'm going home again."?

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Unfortunately, I think that the authors of this study are recommending that if active labour is not reached within 10 hours, straight to theatre - there is no point waiting. The reason for induction is to get the baby out ASAP (for whatever reason - regardless of whether it is valid) so it would be unlikely for 'them' to give up and let the baby stay in, IYKWIM.

This study gives me a funny feeling - without having read it. It just sounds ominous. :(

i am surprised. From this study, less than 8% of inductions result in c/s. I was lead to believe from other posts that the rate was much higher.

hmmmm i see your point, 8% of inductions fail.

I think the failure rate depends on the hospital/ob. In this specific study 8% were classed as failure to progress but i know at least 3 women who had the drip for less (one for only 3 hours and she was at 4cm already!) before that diagnosis was made by their obs. Is it subjective? Like i know some obs call continuous or recurrent heartrate issues, and/or meconium in the waters "distress" but i know of a woman who had a section due to foetal distress and when she got her notes (to read when planning for her VBAC) she had FOUR late fhr decelerations which had stopped by the time the anaesthatist had arrived to do her spinal block, but they went ahead and sectioned anyway, and didn't mention that bubs seemed fine again.

Bec