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Case 46 - A 40-Year-Old at 41 Weeks with a Closed Cervix after 12 Hours of Induction

from Section 6 - Intrapartum/Delivery

Published online by Cambridge University Press:  08 April 2025

Peter F. Schnatz
Affiliation:
The Reading Hospital, Pennsylvania
D. Yvette LaCoursiere
Affiliation:
University of California, San Diego
Christopher M. Morosky
Affiliation:
University of Connecticut School of Medicine
Jonathan Schaffir
Affiliation:
The Ohio State University College of Medicine
Vanessa Torbenson
Affiliation:
Mayo Clinic Alix School of Medicine
David Chelmow
Affiliation:
Virginia Commonwealth School of Medicine
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Summary

Labor induction is common and frequently recommended based on maternal or fetal indications. It may also be chosen by a patient with a term pregnancy after 39 weeks’ gestation. When compared with expectant management, labor induction at term is associated with a reduced risk of cesarean delivery (CD) and the associated maternal and neonatal morbidities in current and subsequent pregnancies. In patients with unfavorable cervices undergoing induction, cervical ripening should be performed prior to administration of oxytocin to reduce the risk of CD and decrease time to delivery. Expected durations of the latent phase of spontaneous labor cannot be applied to induced labor. There are not widely accepted criteria for the diagnosis of a prolonged latent phase of induced labor, or a “failed induction.” The metrics described to diagnose arrest of dilation in the active phase of labor should also not be applied to the latent phase. Cesarean delivery can be avoided by requiring membrane rupture and oxytocin administration for at least 12–18 hours prior to diagnosing a failed induction for nonprogression to the active phase. Consideration should be given to allowing 24 hours or more of induction to enter the active phase if maternal and fetal statuses permit.

Type
Chapter
Information
Pregnancy Complications
A Case-Based Approach
, pp. 141 - 142
Publisher: Cambridge University Press
Print publication year: 2025

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References

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Grobman, WA, Bailit, J, Lai, Y, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Defining Failed Induction of Labor. Am J Obstet Gynecol. 2018;218(1):122.e1122.e8. http://dx.doi.org/10.1016/j.ajog.2017.11.556 (accessed October 11, 2024).Google ScholarPubMed
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