C Le Ray1, M Carayol, G Bréart, F Goffinet. 1. Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, Paris, France.
Abstract
BACKGROUND: Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery. METHODS: We compared cesarean rates according to mode of onset of labor among 5,046 low-risk patients. Violation of the guidelines was defined as induction before 38 weeks or with a Bishop score <5 or with prostaglandins. The cesarean risk was analysed with a bivariable and then a multivariable analysis, which used a multilevel logistic model. RESULTS: Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR=4.1, 95% CI [1.3-12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR=3.2 [1.0-10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor. CONCLUSION: Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.
BACKGROUND: Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery. METHODS: We compared cesarean rates according to mode of onset of labor among 5,046 low-risk patients. Violation of the guidelines was defined as induction before 38 weeks or with a Bishop score <5 or with prostaglandins. The cesarean risk was analysed with a bivariable and then a multivariable analysis, which used a multilevel logistic model. RESULTS:Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR=4.1, 95% CI [1.3-12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR=3.2 [1.0-10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor. CONCLUSION: Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.
Authors: Gláucia Virgínia Guerra; José Guilherme Cecatti; João Paulo Souza; Aníbal Faúndes; Sirlei Siani Morais; Ahmet Metin Gülmezoglu; Renato Passini; Mary Angela Parpinelli; Guillermo Carroli Journal: Bull World Health Organ Date: 2011-07-05 Impact factor: 9.408
Authors: Valery A Danilack; Jennifer A Hutcheon; Elizabeth W Triche; David D Dore; Janet H Muri; Maureen G Phipps; David A Savitz Journal: J Womens Health (Larchmt) Date: 2019-10-29 Impact factor: 2.681