IOL: patients prefer fewer vaginal exams during induction

  • Win ST & al.
  • Am J Obstet Gynecol
  • 8 Jan 2019

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Regular cervical exams during induction of labor (IOL) with oral misoprostol speed time to delivery, but patients do not view them favorably.

Why this matters

  • Women undergoing IOL should discuss regular vs restricted exams with their providers.

Key results

  • Induction time to vaginal delivery interval was shorter with regular vaginal exams vs restricted (24.3 vs 31.1 hours; P=.013).
  • Women had higher satisfaction scores with restricted exams (P<.001 and would recommend this process to a friend>
  • Vaginal delivery rate at 24 hours and satisfaction with birth process were no different between arms.

Study design

  • Randomized, controlled, clinical interventions trial.
  • Nulliparous women ≥37 weeks gestation with indication for IOL were randomly assigned into 2 groups:
    • regular exams every 4 hours with an eye to expedited amniotomy and no further misoprostol when cervix is 2-3 cm (n=101) vs
    • restricted examinations (n=103);
    • both groups received oral misoprostol.
  • At the 12-hour mark in both arms, a vaginal exam was performed if not in labor, and participants were asked about their satisfaction with their induction regimen.
  • Primary outcomes were induction to vaginal delivery interval, 24-hour vaginal delivery rate, and patient satisfaction.
  • Funding: Internal sources only.

Limitations

  • Not powered to assess cesarean delivery rate.

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