INTRODUCTION:In an effort to decrease cesarean delivery rates, an institutional review of inductions performed at or beyond 39 weeks of gestation was designed to identify potential risk factors. METHODS:A retrospective chart review of patients undergoing an induction of labor between 39 and 42 weeks of gestation was performed at a single institution over a 7-month time period. Information abstracted included gestational age, parity, and Bishop score. Records were reviewed to determine induction agents, delivery route, and neonatal outcomes. RESULTS:A total of 236 patients was identified. Of these patients, 104 (44.1%) underwent induction for a medical indication compared with 132 (55.9%) for elective reasons. Overall the cesarean delivery rate was 18.6% (n544) with 75% secondary to a failed induction. Cesarean delivery rates between medical and elective inductions did not vary. When comparing elective inductions, multiparous women presented at a slightly earlier gestation (40.2 compared with 40.8 weeks, P,.005) yet the average Bishop score did not vary. Nulliparous patients who underwent elective induction were 2.3 times more likely to have a cesarean delivery than multiparous patients (26.2% compared with 9.0%, P,.05). The risk of a vacuum-assisted vaginal delivery for nulliparous women was 13.9 times more likely as compared with multiparous patients with elective induction (17% compared with 1.5%, P,.01). Despite no difference in the average Bishop's score, the risk of cervical ripening as a nulliparous patient was 3.09 as compared with multiparous patients (P,.001).CONCLUSIONS: Nulliparity is an independent risk factor for cesarean delivery and operative vaginal delivery in women undergoing elective induction of labor.
INTRODUCTION:A recently published expert opinion on interpretation and management of category II fetal heart tracings was adopted at our institution in 2014. Local Providers expressed concern that implementation of the algorithm may lead to an increase in the primary cesarean section rate for non-reassuring fetal heart tracings. METHODS: A retrospective chart review was performed to assess the potential effect of the algorithm on the cesarean section rate. Term Delivery records for pre and post implementation were reviewed. Inclusion criteria were singleton term pregnancies. Exclusion criteria were preterm pregnancies, multiple gestations, fetal anomalies, abnormal placentation, fetal malposition, uterine anomalies, prior uterine surgery, and other indications for cesarean delivery. Patient data included maternal demographics, obstetrical history and delivery outcomes. The primary outcome was the cesarean section rate. Secondary outcomes included NICU admissions, maternal and neonatal morbidity, and Apgar scores.
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