Failed induction of labor and associated factors among women undergoing induction of labor

Gayatri L. Patil; Tejaswi V. Pujar; Pooja Hombardi; Veda R.

doi:10.18203/2320-1770.ijrcog20260558

Authors

Gayatri L. Patil Department of Obstetrics and Gynecology, S. S. Institute of Medical Sciences & Research Centre (SSIMS & RC), Davangere, Karnataka, India
Tejaswi V. Pujar Department of Obstetrics and Gynecology, S. S. Institute of Medical Sciences & Research Centre (SSIMS & RC), Davangere, Karnataka, India
Pooja Hombardi Department of Obstetrics and Gynecology, S. S. Institute of Medical Sciences & Research Centre (SSIMS & RC), Davangere, Karnataka, India
Veda R. Department of Obstetrics and Gynecology, S. S. Institute of Medical Sciences & Research Centre (SSIMS & RC), Davangere, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260558

Keywords:

Induction of labor, Failed induction, Bishop score, PROM, Cesarean section, Risk factors, Maternal outcome, Neonatal outcome

Abstract

Background: Induction of labor (IOL) is increasingly employed in modern obstetric care, yet carries a significant risk of failure, contributing to higher caesarean rates and associated maternal-neonatal morbidity. Identifying factors that influence IOL success is essential for individualized labor management.

Methods: This prospective observational study was conducted over one year at a tertiary care center in Karnataka, India. A total of 504 women undergoing IOL at ≥37 weeks gestation were enrolled. The induction protocol included mifepristone followed by misoprostol and oxytocin augmentation. Primary outcome was failed induction, defined as failure to enter active labor or caesarean delivery for failed progress. Associations between maternal and obstetric variables and IOL failure were analyzed using chi-square tests.

Results: Out of 504 women, 181 (35.9%) experienced failed induction. PROM was the strongest predictor of failure (81.9%), followed by unfavorable Bishop score <5 (70.8%), maternal age <20 years (76.3%) or >35 years (67.5%), BMI >25 (58.3%), and post-term pregnancy (71.42%). Primigravidity and birth weight >4 kg were also significant contributors. Most caesareans due to failed induction resulted in favorable neonatal outcomes, though a small proportion required NICU admission.

Conclusions: Failed induction is prevalent in women with PROM, low Bishop scores, maternal age extremes, high BMI, and suspected macrosomia. Pre-induction risk stratification and cervical ripening optimization can enhance IOL success and reduce cesarean burden.

References

Bassetty KC, Ahmed RD. Failed induction of labor (IOL): an overview regarding obstetric outcome and its significance in a health resource poor setting over a period of 11 months. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3646-50. DOI: https://doi.org/10.18203/2320-1770.ijrcog20173502

Tadesse T, Assefa N, Roba HS, Baye Y. Failed induction of labor and associated factors among women undergoing induction at University of Gondar Specialized Hospital, Northwest Ethiopia. BMC Pregn Childb. 2022;22(1):175. DOI: https://doi.org/10.1186/s12884-022-04476-7

Zhang J, Troendle J, Reddy UM, Laughon SK, Branch DW, Burkman R, et al. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol. 2010;203(4):326.e1-326.e10. DOI: https://doi.org/10.1016/j.ajog.2010.06.058

Caughey AB, Sundaram V, Kaimal AJ, Cheng YW, Gienger A, Little SE, et al. Maternal and neonatal outcomes of elective induction of labor. Evid Rep Technol Assess (Full Rep). 2009;(176):1-257.

Gupta S, Vyas G, Bhat MP, Jain M. Study of the risk factors for cesarean delivery in induced labor at term. Int J Gynaecol Obstet. 2019;3(2):5-7. DOI: https://doi.org/10.33545/gynae.2019.v3.i2a.02

Vrouenraets FP, Roumen FJ, Dehing CJ, Van den Akker ES, Aarts MJ, Scheve EJ. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstetr Gynecol. 2005;105(4):690-7. DOI: https://doi.org/10.1097/01.AOG.0000152338.76759.38

Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstetr Gynecol. 2011;117(4):805-11. DOI: https://doi.org/10.1097/AOG.0b013e3182114ad2

Tan PC, Vallikkannu, N., Omar, S. Z. (2012). Clinical characteristics associated with successful vaginal delivery following labor induction with Foley catheter and oxytocin in women with PROM at term. Acta Obstetricia et Gynecologica Scandinavica, 91(4), 454–459.

Mercer BM. Preterm premature rupture of the membranes. Obstetr Gynecol. 2003;101(1):178-93. DOI: https://doi.org/10.1016/S0029-7844(02)02366-9

Treacy A, Robson M, O’Herlihy C. Dystocia increases with advancing maternal age. Am J Obstetr Gynecol. 2006;195(3):760-3. DOI: https://doi.org/10.1016/j.ajog.2006.05.052

Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome: a population-based study. Jama. 1992;268(7):886-90. DOI: https://doi.org/10.1001/jama.1992.03490070068044

Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstetr Gynecol. 2004;104(5 Part 1):943-51. DOI: https://doi.org/10.1097/01.AOG.0000142713.53197.91

Weissmann-Brenner A, Simchen MJ, Zilberberg E, Kalter A, Weisz B, Achiron R, et al. Maternal and neonatal outcomes of macrosomic pregnancies. Med Sci Monitor: Int Med J Experim Clin Res. 2012;18(9):PH77. DOI: https://doi.org/10.12659/MSM.883340

Levine EM, Ghai V, Barton JJ, Strom CM. Obstet Gynecol. 2001;97(3):439-42. DOI: https://doi.org/10.1097/00006250-200103000-00023

Ballardini P, Zanardi M, Noce AD, Olivieri I. Clin Exp Rheumatol. 1998;16(5):624-6.