Elective Induction of Labor at Term Compared With Expectant Management

Abstract

OBJECTIVE To test the association of elective induction of labor at term compared with expectant management and maternal and neonatal outcomes. METHODS This was a retrospective cohort study of all deliveries without prior cesarean delivery in California in 2006 using linked hospital discharge and vital statistics data. We compared elective induction at each term gestational age (37–40 weeks) as defined by The Joint Commission with expectant management in vertex, non-anomalous, singleton deliveries. We used multivariable logistic regression to test the association of elective induction and cesarean delivery, operative vaginal delivery, maternal third- or fourth-degree lacerations, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, hyperbilirubinemia, and macrosomia (birth weight greater than 4,000 g) at each gestational week, stratified by parity. RESULTS The cesarean delivery rate was 16%, perinatal mortality was 0.2%, and neonatal intensive care unit admission was 6.2% (N=362,154). The odds of cesarean delivery were lower among women with elective induction compared with expectant management across all gestational ages and parity (37 weeks [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.34–0.57], 38 weeks [OR 0.43, 95% CI 0.38–0.50], 39 weeks [OR 0.46, 95% CI 0.41–0.52], 40 weeks [OR 0.57, CI 0.50–0.65]). Elective induction was not associated with increased odds of severe lacerations, operative vaginal delivery, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, or macrosomia at any term gestational age. Elective induction was associated with increased odds of hyperbilirubinemia at 37 and 38 weeks of gestation and shoulder dystocia at 39 weeks of gestation. CONCLUSION Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management

The association between the regular use of risk-based term IOL and improved birth outcomes in an Italian hospital: A retrospective cohort study

“…Non-indicated term IOL was associated with clinically meaningful and statistically significant decreased odds of term perinatal mortality at all weeks of gestation prior to the estimated date of confinement (EDC, or due date). Finally, a recent large retrospective study of Californian women, using the same approach as the Scottish study, found clinically meaningful and statistically significant decreased odds of CD with non-indicated IOL at every week of the term period, including the early term weeks [42]. Hence, the findings of this Italian study are consistent with a growing body of evidence suggesting that non-indicated IOL might be more beneficial than harmful.…”

“…Finally, most of the observational studies that compared "non-indicated" IOL to spontaneous labour failed to correctly model the actual impact of ni_IOL on the flow of term pregnancy. Specifically, in deciding to perform a ni_ IOL, the actual choice is between delivery now (by "non-indicated" IOL) and delivery later (by either spontaneous labour, some type of IOL at a later date or pre-labour CS) [41,42,54]. Several recent cohort studies that used the correct modeling found that "non-indicated" IOL, as compared with expectant management to a later gestational age, was associated with lower rates of adverse birth outcomes including CD and term stillbirth [40][41][42]55].…”

Perinatal outcomes following an earlier post‐term labour induction policy: a historical cohort study

“…The incidence rate of shoulder dystocia of 0.8% in 2006-08 is still low compared with an American study, which reported an incidence rate of shoulder dystocia of 1.6% in 2006. 34 Hence, shoulder dystocia may previously have been underreported, an explanation that is further supported by the reduction in peripheral nerve injuries. Recently, many obstetric units in Denmark have focused on the management of shoulder dystocia, resulting in a more thorough diagnosis and training of medical staff.…”

Timing of Delivery and Pregnancy Outcomes in Women With Gestational Diabetes

“…Early studies that compared women who undergo IOL to those who experience spontaneous labor at the same gestational age found that IOL was associated with increased risk for CD 4,5 . However, physicians can never chose between spontaneous or induced labor at any given gestational age, and results from studies comparing IOL to expectant management are mixed, with some studies demonstrating a decreased rate of CD [6][7][8][9] , and others an increased risk for CD 10 . An unfavorable bishop score at the time of IOL may be associated with an increased risk for CD, 11,12 but the largest studies have been unable to account for this important covariate.…”