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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(04): e408-e412
DOI: 10.1055/s-0040-1721443
Case Report

Implementation of Evidence-Based Cervical Ripening Protocol: Outcomes and Next Steps

Arthurine Zakama 
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Nasim C. Sobhani 
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Robyn Lamar
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
,
Melissa G. Rosenstein
1   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
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Abstract

Objective A prominent randomized controlled trial demonstrated that low-dose misoprostol with the concurrent cervical Foley shortened the median time to delivery when compared with either method alone. Our study aims to address implementation of this protocol and evaluate its impact on time to delivery.

Study Design This was a retrospective before-and-after study of nulliparous women who delivered nonanomalous, term, singletons at the University of California San Francisco (UCSF) in two separate 2-year periods before and after changes in UCSF's cervical ripening protocol. The primary outcome was time from first misoprostol dose to delivery.

Results A total of 1,496 women met inclusion criteria, with 698 in the preimplementation group and 798 in the postimplementation group. There were no statistically significant differences in time to delivery (29 vs. 30 hours, p = 0.69), rate of cesarean delivery (30 vs. 26%, p = 0.09), or cesarean delivery for fetal indications (11 vs. 8%, p = 0.15) between the groups.

Conclusion Implementing evidence-based low-dose misoprostol with the concurrent cervical Foley did not change the time to delivery, time to vaginal-delivery, or likelihood of vaginal delivery in our population. This may be due to differences in labor management practices and incomplete fidelity to the protocol. Real-world effectiveness of these interventions will vary and should be considered when choosing an induction method.

Keywords

induction of labor - cervical ripening - misoprostol - Foley - quality improvement


Publication History

Received: 15 May 2020

Accepted: 24 September 2020

Article published online:
03 December 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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