Risks of induction of labour in uncomplicated term pregnancies

Abstract

Our objective was to evaluate the risks of maternal and perinatal morbidity associated with induction of labour in uncomplicated term pregnancies. We conducted a retrospective cohort study including 7,430 women, not referred from another institution, with a single baby in vertex presentation, and delivering between 38 and 40 weeks of pregnancy. Among these women, 3,546 were excluded for prelabour pregnancy complications. Relative risks (RR), adjusted for parity, were computed to compare 3,353 women who went into labour spontaneously with 531 women whose labour was induced. Induction of labour was found to be associated with a higher risk of caesarean section [RR = 2.4, 95% CI 1.8, 3.4]. Use of non-epidural [RR = 1.5, 95% CI 1.2, 1.8] and of epidural analgesia [RR = 1.4, 95% CI 1.1, 1.7] was more frequent after labour induction. Resuscitation [RR = 1.2, 95% CI 1.0, 1.5], admission to the intensive care unit [RR = 1.6, 95% CI 1.0, 2.4] and phototherapy [RR = 1.3, 95% CI 1.0, 1.6] were more frequent after induction of labour. Results were similar when controlling simultaneously for parity, maternal age, gestational age, year of delivery, birthweight and the physician in charge of delivery in a logistic regression analysis. The results of this study suggests that induction of labour is associated with a higher risk of caesarean section and of some perinatal adverse outcomes. Induction of labour should be reserved for cases where maternal and perinatal benefits outweigh the risk of these complications.

Elective induction versus spontaneous labour in Latin America

“…This finding conflicts with reports from other authors who found a protective effect. 3,10,26 Giving birth in a private or social security institution was associated with a double or triple risk of elective induction, a finding also in agreement with reports from other studies.…”

“…This finding corroborates reports from various other authors. 10,13,24,33 In the current study, elective induction did not show a significant association with low birth weight. Finally, elective induction in this study was associated with late initiation of breastfeeding.…”

“…3,8,10,27 Not having a partner was a factor associated with a reduced risk of elective induction, and this corroborates the findings of Coonrod et al 8 On the other hand, maternal educational level was not associated with elective induction in our study population, a finding in agreement with the findings of Boulvain et al 10 and Le Ray et al 26 but in disagreement with those of Coonrod et al, 8 who reported a greater risk of elective induction in women with more than 12 years of schooling. However, only 9% of the women in our study fell into this category.…”

“…women with the cervix in a posterior position, firm, poorly effaced and dilated, and with the fetus in a high station). 1,[10][11][12] A caesarean section is usually performed after elective induction with an unripe cervix for the following indications: prolonged first stage of labour, fetal distress, failure to progress and intrapartum haemorrhage. [13][14][15] Some adverse maternal outcomes have been associated with elective induction of labour.…”

Isolated Oligohydramnios at Term as an Indication for Labor Induction: A Systematic Review and Meta-Analysis

“…Older studies have shown conflicting results with a trend towards higher Cesarean section rates when labor induction is attempted [39,40,41]. However, more recent data indicate that this is probably not the case when appropriate control groups are selected.…”