Labor Length Differences in Combination Ripening with 60 versus 30-mL Foley Inflation Volume: A Propensity Score-Matched Study

American Journal of Perinatology · 2026-02-19

Abstract Data support shorter time to delivery with 60 versus 30-mL Foley inflation for labor induction. Similarly, combination cervical ripening has a shorter time to delivery compared with single agents. To date, no study has evaluated incremental benefit of higher Foley volume in the setting of combination ripening methods. This is a secondary analysis of a prospective cohort study evaluating standardized induction management at two sites. Any cervical ripening method could be used. Site no. 1 used 60-mL Foley inflation, whereas Site no. 2 used 30 mL. For this analysis, patients were included if they underwent a term (≥37 weeks) induction from 2020 to 2022 with a singleton, intact membranes, and received combination methods of Foley and another agent. A 1:1 propensity score matching balanced baseline parameters. Of 4,295 inductions, 2,117 (49.3%) utilized combination cervical ripening methods. After propensity score matching, 1,480 were included. Even in the context of combined ripening and standardized induction, Foley inflation to 60 mL was associated with a 3-hour shorter labor length than 30 mL (14.6 [10.4–21.3] vs. 17.7 hours [12.4–24.4], p < 0.001). When censored for cesarean, patients who received 60-mL Foley inflation delivered 70% faster than those who received 30 mL (hazard ratio: 1.73 [1.36–2.21]). There was no difference in cesarean, maternal morbidity, or neonatal morbidity. Even when using combined cervical ripening methods, 60-mL Foley inflation is associated with reduced time to delivery as compared with 30 mL without increasing morbidity.

Antenatal fetal surveillance and iatrogenic delivery

Journal of Perinatal Medicine · 2026-03-02

OBJECTIVES: Antenatal testing is routinely recommended for high-risk pregnancies to reduce the risk of stillbirth, yet limited data guide counseling about likelihood of unscheduled iatrogenic delivery. We explored factors associated with clinical recommendations for unscheduled iatrogenic delivery prompted by antenatal testing and examined variables that influence obstetric outcomes. METHODS: In this retrospective cohort study, we identified singleton pregnancies undergoing serial testing in an academic system from January 2022-May 2023. Indications for testing, recommendations made at the final testing visit before delivery, and obstetric outcomes were obtained. Primary outcomes were unscheduled iatrogenic delivery <39 weeks and unscheduled iatrogenic delivery <37 weeks recommended at the final visit. Stepwise regression models assessed associations between demographics, testing indications, and outcomes. RESULTS: A total of 3,959 patients were included. 11.3 % (n=447) were recommended for delivery based on findings identified at their final testing visit. Of these, 352 patients (8.9 %) underwent unscheduled iatrogenic term delivery <39 weeks, and 156 (3.9 %) underwent unscheduled iatrogenic preterm delivery <37 weeks. After adjustment for confounders, chronic hypertension, hypertensive disorders of pregnancy, fetal growth restriction, and other fetal indications were associated with both primary outcomes. Only 40 % of delivery recommendations were triggered by an abnormal test (NST, mBPP, BPP); most were prompted by other clinical concerns identified during testing encounters. CONCLUSIONS: Patients undergoing antenatal testing should be counseled about the meaningful likelihood of an unscheduled iatrogenic delivery recommendation. Because most recommendations arise from clinical issues unrelated to the testing results themselves, our findings may help clinicians guide shared decision-making around testing frequency and protocols.

Among patients undergoing induction who reach active phase, does prolonged latent phase matter?

The Journal of Maternal-Fetal & Neonatal Medicine · 2025-11-19

OBJECTIVE: We sought to assess whether a prolonged latent phase is associated with increased risk of cesarean delivery (CD) and adverse outcomes among patients undergoing induction of labor (IOL) reaching the active phase. STUDY DESIGN: This was a secondary analysis of a prospective cohort study from 2018-2022 of term, singleton gestations with intact membranes and unfavorable cervix undergoing IOL at two large academic hospitals. Patients who reached active labor (≥6cm dilation) were included. Prolonged latent phase was defined as <6 cm dilated after ≥12 h with ruptured membranes and oxytocin. The primary outcome was CD after reaching active phase. Secondary outcomes included CD for labor arrest and maternal/neonatal morbidity. Analyses were stratified by parity and mode of delivery, and multivariable logistic regression was performed to adjust for confounders. RESULTS: = 0.01). Among patients with a vaginal delivery, a prolonged latent phase was associated with higher maternal morbidity. However, patients who underwent CD had the highest risk of morbidity, regardless of latent phase duration. CONCLUSION: Among term patients undergoing induction with an unfavorable cervix, patients with a prolonged latent phase who ultimately enter active labor have a high rate of vaginal delivery. However, a prolonged latent phase is associated with increased morbidity.

Intrapartum Electronic Fetal Heart Rate Monitoring to Predict Acidemia at Birth With the Use of Deep Learning

Obstetric Anesthesia Digest · 2025-11-18 · 2 citations

( Am J Obstet Gynecol . 2025;232:116.e1-9. DOI: 10.1016/j.ajog.2024.04.022) Electronic fetal monitoring (EFM) is used in more than 85% of births in the United States to help identify signs of fetal distress, particularly hypoxic-ischemic injury. However, its effectiveness in preventing such complications has been limited, and its use has increased obstetric interventions such as cesarean delivery and operative vaginal delivery. Recent advances in deep learning—a branch of artificial intelligence capable of recognizing complex patterns in large datasets—offer new opportunities to enhance the analysis of EFM data.

Signal capture in intrapartum electronic fetal monitoring

American Journal of Obstetrics and Gynecology · 2025-06-02

Cardiac and obstetric outcomes among congenital heart disease patients with repeat pregnancies

American Journal of Obstetrics & Gynecology MFM · 2025-01-02

Intrapartum electronic fetal monitoring and artificial intelligence: a worthwhile endeavor

American Journal of Obstetrics and Gynecology · 2025-04-18

Intrapartum Terbutaline Use and Cesarean Delivery for Labor Dystocia

Journal of Clinical Gynecology and Obstetrics · 2025-10-01

Background: Terbutaline, a β2-adrenergic agonist used to inhibit uterine contractions, is often used to treat fetal heart rate abnormalities, but whether its use increases the risk of labor dystocia remains understudied. Therefore, we sought to assess the association between intrapartum terbutaline use and cesarean delivery (CD) for labor dystocia. Methods: We performed a secondary analysis of a single-center prospective cohort study of patients undergoing induction of labor (IOL) at an urban academic hospital from 2013 to 2015. Participants were singleton, full term with intact membranes, and Bishop score of ≤ 6 and dilation ≤ 2 cm undergoing IOL for any indication. Patients with prior CD were excluded. Patients who received terbutaline at any time during their IOL were compared to patients who did not receive terbutaline. The primary outcome was CD due to labor dystocia (defined as failed IOL, arrest of dilation, or arrest of descent). Results: Of 844 patients, 161 (19%) received terbutaline and 683 (81%) did not. Though the overall rate of CD was higher in the terbutaline group (51% exposed vs. 24% unexposed, P &lt; 0.001), this was primarily driven by CD for fetal distress (26% exposed vs. 4% unexposed, P &lt; 0.001). There was no difference in CD for labor dystocia (24.8% exposed vs. 19.5% unexposed, P = 0.13). Latent phase of labor was longer in the terbutaline group (11.8 h exposed vs. 10.4 h unexposed, P = 0.02), whereas the active phase and second stage of labor were similar between groups. Conclusion: Terbutaline use during labor was not associated with a statistically significant higher risk of CD due to labor dystocia among patients undergoing term IOL.

912 Oxytocin versus oral misoprostol for PROM induction in nulliparas with unfavorable cervix: A randomized trial

American Journal of Obstetrics and Gynecology · 2024-01-01

Oxytocin vs oral misoprostol for PROM induction in nulliparas with unfavorable cervix: a randomized trial

American Journal of Obstetrics & Gynecology MFM · 2024-06-25 · 5 citations