Published: 2017-07-26

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

Karthik Chandra Bassetty, Reena Dutta Ahmed


Background: The aim of the study was to evaluate the indications and outcomes of failed induction in primigravidae in a tertiary care hospital located in a health resource poor setting.

Methods: We conducted a retrospective cross-sectional study on women admitted in the labor room and planned for induction of labor in Assam Medical College and Hospital, Dibrugarh from 1st July 2016 to 31st May 2017. Induction was considered successful if the patient delivered vaginally and failed if it ended up in Caesarean section.

Results: A total of 201 primigravida patients were selected for the study of which 135 patients delivered by CS and 66 patients by spontaneous vaginal delivery. The average induction-delivery interval was found to be 18.9 hours. Average weight of the babies was 2.9 kg. The following factors are associated with increased rates of failed induction: Bishop’s score less than 5, Gestational age >41 weeks, teenage and elderly primi, oligohydramnios, prelabour rupture of membranes (PROM), hypertensive disorders of pregnancy, induction-delivery interval greater than 24 hours, absence of a dating ultrasound done in 1st trimester, meconium stained liquor, SGA and macrosomia babies. There has been a single maternal death due to rupture of uterus.

Conclusions: Most common indication of doing IOL is post-dated pregnancy (>40 weeks of gestation). Majority of women (66%) had no dating ultrasound with them hence they were induced based on last menstrual period which is unreliable in most women leading to failed IOL.IOL protocol i.e. when to repeat and how long to wait was purely the duty consultant’s opinion in our study rather than following a protocol. IOL is an important obstetric procedure hence there is a dire need to develop a protocol for the same in our setup.


Caesarean section, Cerviprime, Failed induction, Labor induction, Post-dated pregnancy

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SOGC Clinical practice guidelines; 2001. Available at

Tenore JL. Methods for cervical ripening and induction of labor. Am Fam Phys. 2003;67(10):2123-8.

Pandis G, Papageorghiou AT, Ramanathan VG, Thompson MO, Nicolaides KH. Preinduction sonographic measurement of cervical length in the prediction of successful induction of labor. Ultrasound Obstet Gynecol. 2001;18(6):623-8.

Gulmezoglu AM, Crowther CA, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2006;4.

Park KH, Hong JS, Ko JK.Comparitive study of induction of labor in nulliparous women with premature rupture of membranesat term compared to those with intact membranes: duration of labor and mode of delivery. J Obstet Gynecol Res. 2006;32:482-8.

Tucker Edmonds B, Fager C, Srinivas S. Predictors of casarean delivery for periviable neonates. Obstet Gynecol. 2011:118:49-56.

Xenakis EM, Piper JM, Field N, et al. Preeclampsia: is induction of labor more successful? Obstet Gynecol. 1997;89:600-3.

Mozurkewich EL, Chilimigras JL, Berman DR. Methods of induction of labor: a systematic review, BMC Pregnancy Childbirth. 2011;27(11):84.

Lin MG, Rouse DJ. What is failed induction ? Clin Obstet Gynecol. 2006;49:585-593.

Caliskan E, Dilbaz S, Gelisen O, Dilbaz B,Ozturk N, Haberal A. Unsuccessful labor induction in women with unfavourable cervical scores: predictors and management. Aus NZ J Obstet Gynecol. 2004;44:562-7.

Park KH, Hong JS, Shin DM, Kang WS. Predictors of failed induction in parous women at term; role of previous obstetric history, digital examination and sonographic measurement of cervical length. J Ostet Gynaec Res. 2009;35:301-6.

Watson WJ, Stevens D, Welter S, Day D. Factors predicting successful labor induction. Obstet Gynecol. 1996:88:990-2.

Satin AJ, Leveno KJ, Sherman ML, McIntire DD. Factors affecting the dose response to oxytocin for induction stimulation. Am J Obstet Gynecol. 1992:166:1260-1.

Chandra S, Crane JMG, Hutchens D, Yg DC. Transvaginal ultrasound and digital examination in predicting successful labor induction. Obstet Gynecol. 2001:98:2-6.

Michelson KA, Carr DB, Easterling TR. The impact of duration of labor induction on caesarean rate. Am J Obstet Gynecol. 2008;199:299.el-4.

Khan NB, Ahmed I, Malik A, Sheikh L. Factors associated with failed induction of labour in a secondary care hospital. JPMA-Journal of the Pakistan Medical Association. 2012;62(1):6.

Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Arts MJ, Scheve EJ. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol. 2005;105:690-7.

Vahratian A, Zhang J, Troendle JF, Scisclone AC, Hoffman MK. Labor progression and risk of cesarean delivery in electively delivery in electively induced nulliparous. Obstet Gynecol. 2005;105:698-704.