obsolete failed induction

Failed Induction: An Outdated Term

The term "failed induction" refers to an outdated concept in obstetrics, where labor induction was considered unsuccessful if it did not progress as expected. This term is no longer commonly used in modern medical practice.

• Definition: The original definition of failed induction was based on the duration of the latent phase, with some studies suggesting that a minimum of 6-8 hours of receiving oxytocin and artificial rupture of membranes should be allowed before considering labor induction as failed [4][14].
• Obsolescence: With advancements in medical technology and changing practices, the term "failed induction" has become less relevant. The focus has shifted towards achieving vaginal birth with minimal maternal or neonatal morbidity, rather than labeling inductions as failures [10].

Current Understanding

In modern obstetrics, labor induction is a widely used practice, with over 1 in 3 women giving birth in the United States undergoing some form of labor induction between 2016 and 2019 [10]. The goal of labor induction remains vaginal birth with minimal maternal or neonatal morbidity.

• Criteria for Success: While there are well-accepted standards for diagnosing arrested active-phase labor, the definition of a "failed" induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase [11][15].
• Implications: If induction were to be designated as “failed” if a woman continued to be in the latent phase at 15 hours after the initiation of oxytocin and rupture of membranes, approximately 70,000 additional cesarean deliveries could be avoided among nulliparous women who undergo induction in the United States every year [12].

References

[1] May 25, 2022 — Failure to Progress is an outdated term that refers to slow labor, and is the most common reason for an unplanned Cesarean.

[4] I had an induction at 40+6 and it failed and was extremely traumatizing. It was excruciatingly painful and my baby's heart rate kept ...

[10] Induction of labor is a widely used practice. From 2016 to 2019, >1 in 3 women giving birth in the United States did so after undergoing labor induction.

[11] While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a “failed” induction of labor remains less certain.

[12] If induction were to be designated as “failed” if a woman continued to be in the latent phase at 15 hours after the initiation of oxytocin and rupture of membranes, approximately 70,000 additional cesarean deliveries could be avoided among nulliparous women who undergo induction in the United States every year.

[14] Failed induction is defined as the inability to achieve regular contractions and cervical change after a minimum of 6–8 hours of receiving the maintenance dose of oxytocin, along with the option of artificial rupture of membranes if feasible.

Failed induction, also known as failure to progress, was an outdated term that referred to slow labor. However, it has been replaced by more accurate and modern terminology.

Historical Context In the past, failed induction was a common reason for unplanned cesarean sections (C-sections). According to Mayo Clinic, risks associated with failed induction included low fetal heart rate, uterine rupture, infection, failed induction itself, which meant a C-section was necessary, and abnormal contractions [5].

Signs of Obsolete Failed Induction The first sign of what was previously considered as uterine rupture (now known as a complication of labor) was usually a marked and abrupt decrease in fetal heart rate (FHR), uterine atony, and loss of fetal presentation height [6][9]. In patients without these symptoms, the condition might have progressed to more severe complications.

Complications Failed induction carried risks such as:

• Low fetal heart rate
• Uterine rupture
• Infection
• Failed induction itself (leading to a C-section)
• Abnormal contractions

These complications highlight the importance of modernizing terminology and understanding in obstetrics to provide better care for mothers and their babies.

References: [5] Mayo Clinic, risks include low fetal heart rate, uterine rupture, infection, failed induction which means a c section is necessary, abnormal ... [6] The first sign of uterine rupture is usually a marked and abrupt decrease in FHR, uterine atony and loss of foetal presentation height. In patients without ... [9] The first sign of uterine rupture is usually a marked and abrupt decrease in FHR, uterine atony and loss of fetal presentation height. In patients without ...

Based on the provided context, it appears that there are several diagnostic tests that can be used to determine if labor induction has failed.

Cardiotocography (CTG) [4] Cardiotocography is a continuous recording of the fetal heart rate obtained via an ultrasound transducer placed on the mother's abdomen. This test can help assess fetal well-being and detect any potential issues during labor induction.

Postoperative ultrasonography [7] Postoperative ultrasonography is usually diagnostic of failed attempted abortion, but it may also be used to evaluate the success of labor induction. However, formal ultrasound consultation is sometimes necessary to confirm the diagnosis.

Oxytocin administration [6, 12] The administration of oxytocin for a minimum requirement of 12 hours after membrane rupture can be an indicator of failed labor induction. If there is no progress into the active phase of labor during this time, it may suggest that labor induction has failed.

Standardized criteria for dystocia diagnosis [8] Using standardized criteria to diagnose dystocia (a condition where labor is not progressing as quickly as expected) can also help determine if labor induction has failed. This approach involves assessing the duration of the latent phase and using oxytocin for induction of labor and stimulation of arrested labor in a defined protocol.

It's worth noting that while these diagnostic tests can be useful, the definition of a "failed" induction of labor remains less certain [14, 15]. Therefore, healthcare providers should carefully reassess the diagnosis and management of dystocia to include sedation, rest, etc. [2] and refine the diagnosis of fetal distress [3].

References: [4] by RM Grivell · 2015 · Cited by 530 [7] by C Antoine · 2021 · Cited by 268 [6] by M Subaha · 2019 [12] [8] by C Antoine · 2021 · Cited by 268 [2] [3] [14] While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a “failed” induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal distress, has not been established. [15] Background: While there are well-accepted standards for the diagnosis of arrested active-phase labor, the definition of a "failed" induction of labor remains less certain. One approach to diagnosing a failed induction is based on the duration of the latent phase. However, a standard for the minimum duration that the latent phase of a labor induction should continue, absent acute maternal or fetal distress, has not been established.

Based on the provided context, it appears that there are various factors to consider when determining the success or failure of an induction of labor.

Failed Induction of Labor

Failed induction of labor is defined as the inability to achieve vaginal delivery after 24 hours or more of induction attempts [3]. This can be due to several reasons, including:

• Low fetal heart rate: If the fetus's heart rate is low, it may indicate that the induction process has not been successful [5].
• Uterine atony: The failure of the uterus to contract properly can lead to a failed induction [7].

Treatment Options

In cases where an induction of labor fails, treatment options may include:

• Oxytocin administration: Oxytocin is often used to stimulate uterine contractions and help progress labor. However, it should be administered at least 12-18 hours after membrane stripping [8].
• Cytotec (misoprostol): Cytotec can be used to stop bleeding caused by uterine atony, but its effectiveness in failed induction cases is unclear.

Other Considerations

It's also worth noting that the choice of induction methods, such as pharmacological, mechanical, or a combination of both, may influence the success or failure of an induction [6].

References:

[3] Workshop summary on preventing the first cesarean delivery (2023) [5] Failed induction. An induction might fail if proper ways to induce don't result in a vaginal delivery after 24 or more hours. (2024) [6] The failure or success of induction may depend on the choice of induction methods, such as the pharmacological, mechanical, or a combination of both. (2022) [7] Cytotec can help stop bleeding if the cause of the hemorrhage is uterine atony, the failure of the muscles to contract. Why Do Doctors Use It? (2023) [8] They also should be given oxytocin at least 12–18 hours after stripping of the membranes. If a woman's labor does not progress, it may be considered a failed induction.

Based on the provided context, it appears that there are various factors to consider when diagnosing a failed induction of labor (IOL). Here are some possible differential diagnoses for an obsolete failed IOL:

• Passage issues: The pelvic architecture or size may be too small to accommodate a vaginal delivery, making it difficult to progress through the latent phase. [7]
• Passenger issues: The fetus may be too large or positioned in a way that makes it difficult to pass through the birth canal, leading to a prolonged latent phase. [15]
• Other obstetric complications: Other conditions such as placenta previa, multiple gestations, or fetal anomalies may contribute to a failed IOL. [14]

It's essential to note that these factors can be complex and multifaceted, requiring a thorough evaluation by healthcare providers to determine the underlying cause of a failed IOL.

In terms of obsolete failed IOL, it's possible that:

• Outdated criteria: The definition or criteria for diagnosing a failed IOL may have changed over time, making previous diagnoses obsolete. [8]
• New evidence-based approaches: New research and guidelines may have been developed to improve the diagnosis and management of IOL, rendering previous practices outdated. [10]

It's crucial to consult up-to-date medical literature and expert opinions to determine the most accurate and current information on diagnosing and managing failed IOL.

References:

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