Elective induction of labor at term compared with expectant management: Maternal and neonatal outcomes

Blair Darney, Jonathan Snowden, Yvonne W. Cheng, Lorie Jacob, James M. Nicholson, Anjali Kaimal, Sascha Dublin, Darios Getahun, Aaron Caughey

Research output: Contribution to journalArticle

98 Citations (Scopus)

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, nonanomalous, 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% (N5362,154). 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.

Original languageEnglish (US)
Pages (from-to)761-769
Number of pages9
JournalObstetrics and Gynecology
Volume122
Issue number4
DOIs
StatePublished - Oct 2013

Fingerprint

Induced Labor
Dystocia
Neonatal Intensive Care Units
Odds Ratio
Mothers
Confidence Intervals
Gestational Age
Hyperbilirubinemia
Lacerations
Parity
Pregnancy
Vital Statistics
Perinatal Mortality
Birth Weight
Cohort Studies
Retrospective Studies
Joints
Logistic Models
Perinatal Death

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Elective induction of labor at term compared with expectant management : Maternal and neonatal outcomes. / Darney, Blair; Snowden, Jonathan; Cheng, Yvonne W.; Jacob, Lorie; Nicholson, James M.; Kaimal, Anjali; Dublin, Sascha; Getahun, Darios; Caughey, Aaron.

In: Obstetrics and Gynecology, Vol. 122, No. 4, 10.2013, p. 761-769.

Research output: Contribution to journalArticle

Darney, Blair ; Snowden, Jonathan ; Cheng, Yvonne W. ; Jacob, Lorie ; Nicholson, James M. ; Kaimal, Anjali ; Dublin, Sascha ; Getahun, Darios ; Caughey, Aaron. / Elective induction of labor at term compared with expectant management : Maternal and neonatal outcomes. In: Obstetrics and Gynecology. 2013 ; Vol. 122, No. 4. pp. 761-769.
@article{41388d17fd4748838faf89ea3d7f6c61,
title = "Elective induction of labor at term compared with expectant management: Maternal and neonatal outcomes",
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, nonanomalous, 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{\%} (N5362,154). 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.",
author = "Blair Darney and Jonathan Snowden and Cheng, {Yvonne W.} and Lorie Jacob and Nicholson, {James M.} and Anjali Kaimal and Sascha Dublin and Darios Getahun and Aaron Caughey",
year = "2013",
month = "10",
doi = "10.1097/AOG.0b013e3182a6a4d0",
language = "English (US)",
volume = "122",
pages = "761--769",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Elective induction of labor at term compared with expectant management

T2 - Maternal and neonatal outcomes

AU - Darney, Blair

AU - Snowden, Jonathan

AU - Cheng, Yvonne W.

AU - Jacob, Lorie

AU - Nicholson, James M.

AU - Kaimal, Anjali

AU - Dublin, Sascha

AU - Getahun, Darios

AU - Caughey, Aaron

PY - 2013/10

Y1 - 2013/10

N2 - 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, nonanomalous, 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% (N5362,154). 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.

AB - 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, nonanomalous, 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% (N5362,154). 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.

UR - http://www.scopus.com/inward/record.url?scp=84889810047&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889810047&partnerID=8YFLogxK

U2 - 10.1097/AOG.0b013e3182a6a4d0

DO - 10.1097/AOG.0b013e3182a6a4d0

M3 - Article

C2 - 24084532

AN - SCOPUS:84889810047

VL - 122

SP - 761

EP - 769

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 4

ER -