- Cesarean delivery (CD) should not be undertaken in the latent phase of labor prior to at least 15 h after rupture of membranes (ROM) and oxytocin initiation.
Why this matters
- There are no clear guidelines on when the diagnosis of failed induction of labor should be made.
- >96% of women entered the active phase by 15 h after the end of cervical ripening, oxytocin initiation, and ROM.
- The longer the duration of the latent phase, the greater the chance of a CD (P<.001).
- Maternal morbidity increased with increasing latent phase.
- Adverse neonatal outcomes were not associated with increased time of the latent phase.
- Cohort data from APEX study, an obstetric cohort of women delivering at 25 US hospitals between 2008 and 2011.
- Nulliparous women at term with cephalic singletons who were induced were included (n=10,677).
- Latent phase defined as beginning after cervical ripening had ended, oxytocin had initiated, and ROM had occurred.
- Active phase was defined as beginning at 5 cm dilation.
- Funding: The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Research Resources.
- The observational nature of this study does not prove causality.