Stephen M Wagner1, Grecio Sandoval2, William A Grobman3, Jennifer L Bailit4, Ronald J Wapner5, Michael W Varner6, John M Thorp7, Mona Prasad8, Alan T N Tita9, George R Saade10, Yoram Sorokin11, Dwight J Rouse12, Jorge E Tolosa13. 1. Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas. 2. George Washington University Biostatistics Center, Washington, District of Columbia. 3. Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 4. MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio. 5. Departments of Obstetrics and Gynecology, Columbia University, New York City, New York. 6. Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah. 7. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 8. Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio. 9. Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama. 10. University of Texas Medical Branch, Galveston, Texas. 11. Wayne State University, Detroit, Michigan. 12. Brown University, Providence, Rhode Island. 13. Oregon Health & Science University, Portland, Oregon.
Abstract
OBJECTIVE: Our objective was to compare outcomes among low-risk parous women who underwent elective labor induction at 39 weeks versus expectant management. STUDY DESIGN: This is a secondary analysis of an observational cohort of 115,502 mother-infant dyads who delivered at 25 hospitals between 2008 and 2011. The inclusion criteria for this analysis were low-risk parous women with nonanomalous singletons with at least one prior vaginal delivery after 20 weeks, who delivered at ≥390/7 weeks. Women who electively induced between 390/7 and 396/7 weeks were compared with women who expectantly managed ≥390/7 weeks. The primary outcome for this analysis was cesarean delivery. Secondary outcomes were composites of maternal adverse outcome and neonatal adverse outcome. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR). RESULTS: Of 20,822 women who met inclusion criteria, 2,648 (12.7%) were electively induced at 39 weeks. Cesarean delivery was lower among women who underwent elective induction at 39 weeks than those who did not (2.4 vs. 4.6%, adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.53-0.92). The frequency of the composite maternal adverse outcome was significantly lower for the elective induction cohort as well (1.6 vs. 3.1%, aOR: 0.66, 95% CI: 0.47-0.93). The composite neonatal adverse outcome was not significantly different between the two groups (0.3 vs. 0.6%; aOR: 0.60, 95% CI: 0.29-1.23). CONCLUSION: In low-risk parous women, elective induction of labor at 39 weeks was associated with decreased odds of cesarean delivery and maternal morbidity, without an increase in neonatal adverse outcomes. KEY POINTS: · 39-week elective induction is associated with decreased cesarean delivery in low-risk parous women.. · Compared with expectant management, maternal adverse outcomes were lower with elective induction.. · Neonatal adverse outcomes are unchanged between elective and expectant management groups.. Thieme. All rights reserved.
OBJECTIVE: Our objective was to compare outcomes among low-risk parous women who underwent elective labor induction at 39 weeks versus expectant management. STUDY DESIGN: This is a secondary analysis of an observational cohort of 115,502 mother-infant dyads who delivered at 25 hospitals between 2008 and 2011. The inclusion criteria for this analysis were low-risk parous women with nonanomalous singletons with at least one prior vaginal delivery after 20 weeks, who delivered at ≥390/7 weeks. Women who electively induced between 390/7 and 396/7 weeks were compared with women who expectantly managed ≥390/7 weeks. The primary outcome for this analysis was cesarean delivery. Secondary outcomes were composites of maternal adverse outcome and neonatal adverse outcome. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR). RESULTS: Of 20,822 women who met inclusion criteria, 2,648 (12.7%) were electively induced at 39 weeks. Cesarean delivery was lower among women who underwent elective induction at 39 weeks than those who did not (2.4 vs. 4.6%, adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.53-0.92). The frequency of the composite maternal adverse outcome was significantly lower for the elective induction cohort as well (1.6 vs. 3.1%, aOR: 0.66, 95% CI: 0.47-0.93). The composite neonatal adverse outcome was not significantly different between the two groups (0.3 vs. 0.6%; aOR: 0.60, 95% CI: 0.29-1.23). CONCLUSION: In low-risk parous women, elective induction of labor at 39 weeks was associated with decreased odds of cesarean delivery and maternal morbidity, without an increase in neonatal adverse outcomes. KEY POINTS: · 39-week elective induction is associated with decreased cesarean delivery in low-risk parous women.. · Compared with expectant management, maternal adverse outcomes were lower with elective induction.. · Neonatal adverse outcomes are unchanged between elective and expectant management groups.. Thieme. All rights reserved.
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