Implementation of Dual Ripening for Induced Labor as a Part of a Promoting Vaginal Birth Initiative Decreased Length of Labor and Quantified Blood Loss [ID 1641]

INTRODUCTION: Promoting vaginal birth (PVB) toolkits have helped improve labor management and decrease rates of cesarean births, but focus on spontaneous labor, despite the growing rate of labor inductions. This study assessed the effect of adding dual ripening, an induction tool shown to reduce neonatal morbidity, time to delivery, and cesarean birth, to a PVB initiative. METHODS: This retrospective cohort study compared patients with singleton, viable pregnancies, dilation less than 4, Bishop less than 9, and intact membranes undergoing induction in the 10 months pre- and post-implementation of policies and education to increase dual ripening (DR). The primary outcome was the time to delivery, and secondary outcomes were quantitative blood loss and cesarean birth rate. Chart abstraction was used to obtain data and covariate-adjusted regression models were used to assess associations (IRB approval #02002114). RESULTS: Four hundred fifty-five patients were included, 226 pre-DR and 209 post-DR, with similar baseline characteristics between cohorts. Post-DR, the rate of dual ripening increased from 21% to 55% ( P <.00001). Induction time decreased by 9.86 hours (95% CI, −12.67, −7.05; P <.0001) and QBL decreased by 410 mL (95% CI, −678, −142; P =.002). The rate of CS decreased from 26% to 18% ( P =.046). When adjusted, the odds of having a cesarean birth were 39% lower post-DR (95% CI, 0.37, 1.00; P =.05). CONCLUSIONS/IMPLICATIONS: There was a substantial decrease in the time to delivery and quantitative blood loss for patients undergoing induction after interventions to increase rate of DR. Although the decrease in rate of cesarean birth was not statistically significant, it was clinically meaningful, indicating value to expanding PVB toolkits to include tools for induction such as dual ripening.