Outcomes of Elective Induction of Labor at 39 Weeks from a Statewide Collaborative Quality Initiative

Abstract

Objective This article evaluates the impact of adopting a practice of elective induction of labor (eIOL) at 39 weeks among nulliparous, term, singleton, vertex (NTSV) pregnancies in a statewide collaborative. Study Design We used data from a statewide maternity hospital collaborative quality initiative to analyze pregnancies that reached 39 weeks without a medical indication for delivery. We compared patients who underwent an eIOL versus those who experienced expectant management. The eIOL cohort was subsequently compared with a propensity score-matched cohort who were expectantly managed. The primary outcome was cesarean birth rate. Secondary outcomes included time to delivery and maternal and neonatal morbidities. Chi-square test, t-test, logistic regression, and propensity score matching methods were used for analysis. Results In 2020, 27,313 NTSV pregnancies were entered into the collaborative's data registry. A total of 1,558 women underwent eIOL and 12,577 were expectantly managed. Women in the eIOL cohort were more likely to be ≥35 years old (12.1 vs. 5.3%, p < 0.001), identify as white non-Hispanic (73.9 vs. 66.8%, p < 0.001), and be privately insured (63.0 vs. 61.3%, p = 0.04). When compared with all expectantly managed women, eIOL was associated with a higher cesarean birth rate (30.1 vs. 23.6%, p < 0.001). When compared with a propensity score-matched cohort, eIOL was not associated with a difference in cesarean birth rate (30.1 vs. 30.7%, p = 0.697). Time from admission to delivery was longer for the eIOL cohort compared with the unmatched (24.7 ± 12.3 vs. 16.3 ± 11.3 hours, p < 0.001) and matched (24.7 ± 12.3 vs. 20.1 ± 12.0 hours, p < 0.001) cohorts. Expectantly managed women were less likely to have a postpartum hemorrhage (8.3 vs. 10.1%, p = 0.02) or operative delivery (9.3 vs. 11.4%, p = 0.029), whereas women who underwent an eIOL were less likely to have a hypertensive disorder of pregnancy (5.5 vs. 9.2%, p < 0.001). Conclusion eIOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate. Key Points

A prolonged latent phase: An early career in oxytocin during birth

“…Until this day, I already believed in the importance of the birthing process. As an undergraduate at the University of Michigan, a Women's Studies course on Women's Health taught by (now) renown Nurse-Midwife researcher, Dr. Lisa Kane Low [ 1 ], introduced me to women's reproductive health in a way that felt simultaneously grounding and horrifying. Using a feminist framework, I, alongside a hundred other 19-year-olds, absorbed the complicated history of current obstetric and gynecologic clinical practices with many misogynist or racist underpinnings [ [2] , [3] , [4] ].…”

“…Addressing maternal morbidity and mortality in the United States has become a social, policy and funding priority with growing awareness of shameful and discouraging population trends of rising maternal deaths [ 85 ] and exacerbated disparities between racial groups and economic strata [ 86 ]. The increasing clinical practice trends toward more labor inductions occurring earlier in pregnancy [ 1 ] is also likely, in my review of the evidence, to do nothing to reverse climbing rates of postpartum hemorrhage and blood transfusion [ 77 , 87 ]. We have a long way to go to uncover answers to variability in birth outcomes and develop new tools in obstetrics and midwifery.…”