Labor
Poster Session 2
LeAnn A. Louis, MD MPH (she/her/hers)
Resident Physician
University of Michigan Hospital System
Ann Arbor, MI, United States
Anita M. Malone, MD, MPH
University of Michigan
Ann Arbor, MI, United States
Rebecca F. Hamm, MD, MSCE (she/her/hers)
Assistant Professor of Obstetrics and Gynecology
Perelman School of Medicine, University of Pennsylvania
Philadelphia, PA, United States
Jourdan E. Triebwasser, MD, MA (she/her/hers)
Assistant Professor of Obstetrics and Gynecology
University of Michigan
Ann Arbor, MI, United States
Limited data suggests standardized induction of labor (IOL) improves outcomes for Black birthing people. To assess the impact and uptake of a standardized protocol for IOL by self-reported race.
We conducted a single center quality improvement project to examine the impact of standardizing IOL with use of 3 evidence-based practices: 1) dual agent cervical ripening with foley; 2) vaginal misoprostol instead of buccal; and 3) early amniotomy (≤ 4 cm). We compared IOL length and cesarean before-implementation (PRE, 11/1/21-1/31/22) and after (POST, 3/1/22-4/30/22). Singleton IOL with intact membranes, initial cervical dilation ≤ 2 cm, and self-reported non-Hispanic (NH) Black or NH White race/ethnicity were included. Prior cesarean and stillbirth were excluded. Chi-squared and rank sum tests were used for bivariate comparisons. Time to delivery was compared PRE to POST with Cox proportional hazard models, stratified by race, adjusting for nulliparity, age, and body mass index (BMI).
Of 407 included, 18.9% (N=77) were NH Black and 81.1% where NH White (N=330). NH Black patients were younger (29.5 vs. 31.6 years, p< 0.01), had higher BMI (35.5 vs. 31.3 kg/m2, p< 0.01), and were less likely to be nulliparous (42.9% vs. 59.6%, p< 0.01). There was a significant increase in use of only vaginal misoprostol for both groups (p< 0.01) and early amniotomy among NH White (p=0.01, Figure). IOL length decreased among NH White (21.3 [IQR 13.2-31.0] vs. 18.3 h [IQR 12.3-25.3], p=0.02); the difference was not significant for NH Black (22.9 [IQR 14.2-29.2] vs. 20.0 h [IQR 13.4-29.8], p=0.53). After adjustment, time to delivery was shorter for NH White (HR 1.52, 95% CI 1.21-1.91) but not NH Black (HR 1.30, 95% CI 0.79-2.12). This may be due to limited sample size. Cesarean birth was no different PRE vs. POST for NH Black (22.5 vs. 28.6%, p=0.55) or NH White (28.6 vs. 26.3%, p=0.64).
Standardizing IOL has the potential to improve IOL and limit biases in care; however, barriers to implementation of evidence-based practices need to be addressed to optimize outcomes for Black pregnant people.