American Journal of Obstetrics and Gynecology
ResearchObstetricsInduction of labor compared to expectant management in low-risk women and associated perinatal outcomes
Section snippets
Materials and Methods
This is a retrospective study of maternal and infant data from live births delivered in the United States in 2005, using the Vital Statistics Natality birth certificate registry provided by the Centers for Disease Control and Prevention. This dataset includes all live births to US and non-US residents occurring in the 50 United States, the District of Columbia, the Virgin Islands, and US territories. The 2005 birth certificate data could be collected by using the 2003 version of the US Standard
Results
There were 442,003 low-risk nulliparous women who met study inclusion criteria. The majority of women were between the age of 20-34 years (73.3%), of non-Hispanic white race/ethnicity (62.5%), had >8 years of education (80.8%), had gestational weight gain <35 lb (58.2%), and has at least 8 prenatal care visits (89.8%) (Table 1).
Comparing women who had induction at 39 weeks' GA to women delivered at a later GA (40, 41, or 42 weeks), the frequency of cesarean was 26.2% among those who had
Comment
In this large cohort of nulliparous women who delivered singleton live births between 39-42 weeks, we observed that induction of labor was not associated with an increased risk of cesarean delivery compared to delivery at a later GA. While a majority of previous observational studies compared women who had induction of labor to spontaneous labor at similar GA and reported increased risk of cesarean, our analytic scheme more accurately reflects the clinical management options: either to undergo
References (26)
- et al.
Neonatal complications of term pregnancy: rates by gestational age increase in a continuous, not threshold, fashion
Am J Obstet Gynecol
(2005) - et al.
Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions
Am J Obstet Gynecol
(1999) - et al.
Postterm with favorable cervix: is induction necessary?
Eur J Obstet Gynecol Reprod Biol
(2003) - et al.
Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis
Obstet Gynecol
(2003) - et al.
Induction of labor and cesarean delivery by gestational age
Am J Obstet Gynecol
(2006) - et al.
Women's perceptions, expectations and satisfaction with induced labor–a questionnaire-based study
Eur J Obstet Gynecol Reprod Biol
(2005) - et al.
Births: final data for 2008
Natl Vital Stat Rep
(2010) - et al.
Births: final data for 2006
Natl Vital Stat Rep
(2009) American College of Obstetricians and Gynecologists practice bulletin no. 107: induction of labor
Obstet Gynecol
(2009)ACOG practice bulletin no. 55 (replaces practice pattern no. 6, October 1997): management of postterm pregnancy
Obstet Gynecol
(2004)
Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix
Am J Obstet Gynecol
Bishop score and risk of cesarean delivery after induction in nulliparous women
Obstet Gynecol
Labor progression and risk of cesarean delivery in electively induced nulliparas
Obstet Gynecol
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2020, Best Practice and Research: Clinical Obstetrics and GynaecologyPatients’ perspectives regarding induction of labor in the absence of maternal and fetal indications: are our patients ready for the ARRIVE trial?
2020, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :Specifically, as women express concern about the possibility of fetal harm with IOL in the absence of maternal or fetal indications, practitioners may consider reassuring patients that the ARRIVE trial did not find significant differences in their primary outcome (a composite of adverse perinatal outcomes) between IOL at 39 weeks vs expectant management.4 Further, previous studies7,16,17 and a newly published meta-analysis18 report conclusions similar to those of the ARRIVE trial regarding perinatal outcomes. It is our hope that these data can help practitioners to better communicate with their patients when discussing the option of IOL in the absence of maternal or fetal indications, prioritizing the discussion of perinatal outcomes to address patient concerns.
Y.W.C. is supported by the University of California San Francisco Women's Reproductive Health Research Career Development Award, National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12 HD001262).
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Cheng YW, Kaimal AJ, Snowden JM, et al. Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes. Am J Obstet Gynecol 2012;207:502.e1-8.