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    Induction success or failure: Does maternal age matter?


    “The fact that over the last several decades, women have increasingly decided to postpone their first pregnancy makes our cohort more relevant than before,” Dr Hiersch told Contemporary OB/GYN.

    As another difference compared with other studies that have investigated outcomes of labor induction, the current study also included a cohort of women who received the prostaglandin E2 insert.

    “Other studies did not distinguish among the different methods available for labor induction. We think clinicians can benefit from the findings of our study that specifically addressed use of the prostaglandin E2 vaginal insert,” Dr Hiersch said.

    He acknowledged that the research has limitations because of its retrospective design. Consequently, information was missing on some factors that may contribute to labor induction failure, such as maternal gestational weight gain. In addition, the group of older nulliparous women was relatively small.

    “As an important strength, however, our study was conducted in a single center where a uniform protocol for labor induction is in place,” Dr Hiersch said.

    According to the center’s protocol for labor induction, a 10 mg dinoprostone slow-release vaginal insert is placed to the vaginal posterior fornix and continued for up to 24 hours. It is removed earlier if the Bishop score is >7 or if there is uterine tachysystole or a non-reassuring fetal heart rate on monitoring. Among the 148 women who failed labor induction, an unfavorable Bishop score at 24 hours after prostaglandin E2 vaginal insert placement was the most common reason (74.3%).

    The 537 women included in the study represented 3.5% of a total of 15,564 deliveries at the medical center during the 3-year study period from January 2012 to December 2014.



    1. Hadar E, Hiersch L, Ashwal E, et al. Induction of labor in elderly nulliparous women. J Matern Fetal Neonatal Med. 2016 Sep 27:1-17. [Epub ahead of print]



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