When can we call it a failed induction of labor?

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  • 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.

Key results

  • >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.

Study design

  • 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.