Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis

Fonseca, Maria João; Santos, Fernanda Batista Oliveira; Afreixo, Vera; Silva, Isabel Santos; Almeida, Maria do Céu

doi:10.1016/j.ejogrb.2020.08.022

Cited by 14 publications

(17 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent evidence from the ARRIVE trial demonstrated that IOL in low-risk nulliparous women at 39 weeks’ gestation reduced the rates of C/S (18.6% versus vs. 22.2%; p < 0.001) and hypertensive disorders (9.1% vs. 14.1%; p < 0.001) [ 5 ]. The results of the trial are also comparable with those of other meta-analyses and these findings led to a transformation of the concept of IOL and made IOL more acceptable in clinical practice [ 6 , 7 , 8 ].…”

Section: Introductionsupporting

confidence: 71%

Comparison of the Dinoprostone Vaginal Insert and Dinoprostone Tablet for the Induction of Labor in Primipara: A Retrospective Cohort Study

Ting

Ding

Wei

2022

JCM

View full text Add to dashboard Cite

This retrospective study aimed to compare the safety and efficacy of Prostin E2 and Propess for the induction of labor (IOL) in nulliparous women between January 2018 and October 2021. The inclusion criteria were nulliparous, singleton, >37 weeks’ gestation, cephalic presentation with an unfavorable cervix (Bishop score ≤ 6), no signs of labor, and use of one form of dinoprostone (Prostin E2 or Propess) for IOL. The cesarean section (C/S) rate and induction-to-birth interval were the main outcome measures. In total, 120 women were recruited. Sixty (50%) patients received Propess and 60 (50%) received repeated doses of Prostin E2. The Prostin E2 and Propess groups had similar patient characteristics, but the Bishop score was significantly higher in the Propess group than in the Prostin E2 group; therefore, multivariate analysis was conducted, and the Bishop score was not associated with the induction-to-birth interval. The C/S rate was not significantly different between the two groups, but the Propess group achieved a shorter induction-to-birth interval, a higher rate of vaginal delivery in 24 h, and a lower number of vaginal examinations than the Prostin E2 group. Propess was effective and safe in IOL and could be an option for cervical ripening in nulliparous pregnancy.

show abstract

Section: Introductionsupporting

confidence: 71%

Comparison of the Dinoprostone Vaginal Insert and Dinoprostone Tablet for the Induction of Labor in Primipara: A Retrospective Cohort Study

Ting

Ding

Wei

2022

JCM

View full text Add to dashboard Cite

show abstract

“…In women of AMA, induction of labor decreased the risk of cesarean delivery by 30% in our study (OR 0.7, CI 0.5–0.9, P <.03). However, a recent meta-analysis of of six randomized clinical trials including 958 patients with low heterogeneity, comparing induction of labor with expectant management in singleton pregnancies at term in women of AMA, showed no significant difference; 21 The pooled odds ratio was 0.97 (95 % CI=0.86–1.1). Most likely the estimate from the meta-analysis is more accurate.…”

Section: Discussionmentioning

confidence: 97%

Comparison of pregnancy outcomes between women of advanced maternal age (≥35 years) versus younger women in a tertiary care center in Saudi Arabia

et al. 2021

View full text Add to dashboard Cite

BACKGROUND: Pregnancy in women aged 35 years or above is generally considered an advanced maternal age (AMA). AMA is associated with an increased rate of maternal and neonatal complications. OBJECTIVES: Assess the effect of AMA on maternal and neonatal outcomes. DESIGN: Analytical cross-sectional study of medical records. SETTINGS: In-patient hospital tertiary care setting in Jeddah. PATIENTS AND METHODS: All women who attended antenatal care and delivered at King Abdulaziz Medical City in Jeddah in the first half of 2018 were included in the study. Outcomes for women 35 years of age or older were compared with younger women. Significant factors in a univariate analysis were entered in a multiple logistic regression model to assess the association between AMA and outcomes. MAIN OUTCOME MEASURES: Rates of maternal neonatal complications, analysis of factors associated with advanced maternal, gestational diabetes mellitus (GDM), cesarean delivery. SAMPLE SIZE: 1586 women. RESULTS: Of the 1586 women, 406 were 35 years of age or older (25.6%), and 1180 were younger than 35 years. The AMA group had a significantly higher proportion of GDM (32.0% versus 13.2%, P <.001). The adjusted odds ratio (OR) for GDM was 2.6 (95% CI 2–3.5, P <.001.) compared with younger women in the multivariate logistic regression analysis. Older women had a higher rate of cesarean delivery (43.6% versus 30.8%, P <.001). The adjusted OR for cesarean vs. vaginal delivery was 1.5 (CI 1.2–1.9, P =.002). CONCLUSION: Pregnancy in women 35 years or older was associated with an increased risk of GDM and cesarean delivery. LIMITATIONS: Cross-sectional design, small sample size, single hospital. CONFLICT OF INTEREST: None.

show abstract

“…11 The results indicated that women who were 25 years and older had an increased odds of cesarean birth overall, and this increase remained regardless of elective IOL or expectant management, which is consistent with other study findings. 12 Women who are of advanced maternal age have also been found to have increased rates of antepartum complications such as hypertensive disorders and intrauterine fetal death, particularly beyond 39 weeks' gestation. 12,13 However, advanced maternal age has not been established as a medical indication for IOL.…”

Section: Discussionmentioning

confidence: 99%

“…12 Women who are of advanced maternal age have also been found to have increased rates of antepartum complications such as hypertensive disorders and intrauterine fetal death, particularly beyond 39 weeks' gestation. 12,13 However, advanced maternal age has not been established as a medical indication for IOL. In the United States, there are increasingly larger numbers of women delaying their first pregnancies until 35 years or more.…”

Section: Discussionmentioning

confidence: 99%

Elective Induction of Labor or Expectant Management: Outcomes Among Nulliparous Women with Uncomplicated Pregnancies

Lewis

Zhao

Schorn

2022

J Midwife Womens Health

View full text Add to dashboard Cite

Introduction: Cesarean birth rates among women who are nulliparous with uncomplicated full-term pregnancies have been shown to decrease if labor is electively induced. The purpose of this study was to compare the cesarean birth rate for women with pregnancies at 39.0 weeks' gestation or later admitted for spontaneous labor or medically indicated induction of labor (IOL) with that of women receiving elective IOL at term. Methods:A retrospective cohort study was conducted by searching electronic health records of all nulliparous women with uncomplicated pregnancies who gave birth between January 2018 through February 2020 at one academic medical center. Select maternal demographic data and approach to labor management were the primary variables analyzed in determining the odds of cesarean birth.Results: A total of 1528 women were included in this study. Among these, 158 received elective IOL, and 1370 did not. The cesarean birth rates (31.0% vs 23.9%, elective induction of labor vs expectant management, respectively, P = .048), neonatal intensive care admissions (9.5% vs 7.6%, P = .41), and Apgar scores were similar among women in both management groups, respectively (P = .08). Accounting for other potential risk factors, the odds of having cesarean birth were not statistically different between management groups (adjusted odds ratio, 0.73; 95% CI, 0.5-1.1; P = .09). There were 2 fetal deaths among women whose labor was not electively induced. In the total cohort, women who were older, who had higher body mass index (BMI), and who identified as non-Hispanic Black had an increased odds of experiencing a cesarean birth. The associations between women in management groups and cesarean birth were not modified by age, BMI, race, or ethnicity (P = .33, .67, and .87, respectively).Discussion: Elective IOL was not associated with lower cesarean rates in this study. Further research is needed before implementing clinical practice changes that encourage more use of IOL.

show abstract

Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis

Cited by 14 publications

References 33 publications

Comparison of the Dinoprostone Vaginal Insert and Dinoprostone Tablet for the Induction of Labor in Primipara: A Retrospective Cohort Study

Comparison of the Dinoprostone Vaginal Insert and Dinoprostone Tablet for the Induction of Labor in Primipara: A Retrospective Cohort Study

Comparison of pregnancy outcomes between women of advanced maternal age (≥35 years) versus younger women in a tertiary care center in Saudi Arabia

Elective Induction of Labor or Expectant Management: Outcomes Among Nulliparous Women with Uncomplicated Pregnancies

Contact Info

Product

Resources

About