Research
Obstetrics
Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes

https://doi.org/10.1016/j.ajog.2012.09.019Get rights and content

Objective

We sought to examine the association of labor induction and perinatal outcomes.

Study Design

This was a retrospective cohort study of low-risk nulliparous women with term, live births. Women who had induction at a given gestational age (eg, 39 weeks) were compared to delivery at a later gestation (eg, 40, 41, or 42 weeks).

Results

Compared to delivery at a later gestational age, those induced at 39 weeks had a lower risk of cesarean (adjusted odds ratio [aOR], 0.90; 95% confidence interval [CI], 0.88–0.91) and labor dystocia (aOR, 0.88; 95% CI, 0.84–0.94). Their neonates had lowered risk of having 5-minute Apgar <7 (aOR, 0.81; 95% CI, 0.72–0.92), meconium aspiration syndrome (aOR, 0.30; 95% CI, 0.19–0.48), and admission to neonatal intensive care unit (aOR, 0.87; 95% CI, 0.78–0.97). Similar findings were seen for women who were induced at 40 weeks compared to delivery later.

Conclusion

Induction of labor in low-risk women at term is not associated with increased risk of cesarean delivery compared to delivery later.

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

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      Citation 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.

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    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.

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