ArticleCureus2026
Safety and Efficacy of Sequential Labor Induction Methods After Failed Primary Induction of Labor: A Retrospective Cohort Study.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInduction of labor (IOL) is a common obstetric intervention; however, management following failed primary induction remains clinically challenging. Sequential use of pharmacological and mechanical induction methods is practiced in many institutions, although evidence supporting this approach remains limited.
objectiveTo evaluate the safety and effectiveness of sequential induction strategies using prostaglandin E MATERIALS AND
methodsThis retrospective cohort study was conducted at Ibri Regional Hospital in Oman between January 2023 and December 2025. Women with singleton cephalic pregnancies at ≥37 weeks' gestation who failed an initial induction course and subsequently underwent sequential induction were included. Participants were categorized into six groups (A-F) according to the induction sequence used. Group F (n = 1) was included in the overall cohort but was reported descriptively and excluded from inferential analyses because of the single-case limitation. The primary outcome was vaginal delivery. Secondary outcomes included achievement of active labor, induction-to-delivery interval, mode of delivery, maternal complications, and neonatal outcomes. Statistical analyses were performed using IBM SPSS Statistics version 29.0 (IBM Corp., Armonk, New York, USA). The Kruskal-Wallis test and chi-square test were used for group comparisons, with p < 0.05 considered statistically significant.
resultsA total of 145 women underwent sequential induction. Among groups A-E, 125 women (86.8%) achieved active labor, and 96 (66.7%) had a spontaneous vaginal delivery. Rates of progression to active labor did not differ significantly among groups A-E (p = 0.353). Among women who achieved active labor, vaginal delivery rates differed significantly according to the induction sequence used (p < 0.001), with the highest rate observed in the repeated PGE
conclusionSequential induction following failed primary IOL was associated with acceptable maternal and neonatal outcomes in the study cohort, and the strategies involving dinoprostone formulations may be associated with a reduced likelihood of cesarean delivery in selected patients. Prospective studies with standardized protocols and multivariable adjustment are required to determine the optimal sequencing strategy.
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