Induction of labor and cesarean delivery by gestational age

Aaron Caughey, James M. Nicholson, Yvonne W. Cheng, Deirdre J. Lyell, A. Eugene Washington

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Objective: Studies of cesarean delivery (CD) rates among women undergoing induction of labor (IOL) often compare such women to women experiencing spontaneous labor at similar gestational ages. We sought to examine the association between IOL at various gestational ages and CD, accounting for the effect of increased gestational age among the comparison group who were managed expectantly. Study design: We conducted a retrospective cohort study of all term, singleton, cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor. For each gestational age of induction, we created a comparison group of women who were undelivered at that gestational age, and who experienced labor at some future gestational age. Results: In women undergoing IOL at 38 weeks gestation, the CD rate was 11.9% as compared to 13.3% (P = .42) of women beyond 38 weeks gestation. The CD rate for induction of labor compared to ongoing pregnancy was 14.3% versus 15.0% (P = .62) at 39 weeks, 20.4% versus 19.0% (P = .41) at 40 weeks, and 24.3% versus 26.0% (P = .39) at 41 weeks. When controlling for potential confounding, there was a higher rate of CD among women with expectant management beyond 38 weeks (adjusted odds ratio [AOR] 1.80; 95% CI 1.29-2.53), 39 weeks (1.39; 95% CI 1.08-1.80), and 40 weeks (AOR 1.27; 95% CI 1.00-1.62). Conclusion: Our findings suggest that IOL may not increase a woman's risk of CD when compared to expectant management. While this question has been addressed prospectively at 41 weeks gestation, it requires further examination at earlier gestations and among various subgroups.

Original languageEnglish (US)
Pages (from-to)700-705
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume195
Issue number3
DOIs
StatePublished - Sep 2006
Externally publishedYes

Fingerprint

Induced Labor
Gestational Age
Pregnancy
Odds Ratio
Cohort Studies
Retrospective Studies
Head

Keywords

  • Cesarean delivery, gestational age, perinatal epidemiology
  • Labor induction

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Induction of labor and cesarean delivery by gestational age. / Caughey, Aaron; Nicholson, James M.; Cheng, Yvonne W.; Lyell, Deirdre J.; Washington, A. Eugene.

In: American Journal of Obstetrics and Gynecology, Vol. 195, No. 3, 09.2006, p. 700-705.

Research output: Contribution to journalArticle

Caughey, Aaron ; Nicholson, James M. ; Cheng, Yvonne W. ; Lyell, Deirdre J. ; Washington, A. Eugene. / Induction of labor and cesarean delivery by gestational age. In: American Journal of Obstetrics and Gynecology. 2006 ; Vol. 195, No. 3. pp. 700-705.
@article{abe7467b70b94778ba2751f3d2df95de,
title = "Induction of labor and cesarean delivery by gestational age",
abstract = "Objective: Studies of cesarean delivery (CD) rates among women undergoing induction of labor (IOL) often compare such women to women experiencing spontaneous labor at similar gestational ages. We sought to examine the association between IOL at various gestational ages and CD, accounting for the effect of increased gestational age among the comparison group who were managed expectantly. Study design: We conducted a retrospective cohort study of all term, singleton, cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor. For each gestational age of induction, we created a comparison group of women who were undelivered at that gestational age, and who experienced labor at some future gestational age. Results: In women undergoing IOL at 38 weeks gestation, the CD rate was 11.9{\%} as compared to 13.3{\%} (P = .42) of women beyond 38 weeks gestation. The CD rate for induction of labor compared to ongoing pregnancy was 14.3{\%} versus 15.0{\%} (P = .62) at 39 weeks, 20.4{\%} versus 19.0{\%} (P = .41) at 40 weeks, and 24.3{\%} versus 26.0{\%} (P = .39) at 41 weeks. When controlling for potential confounding, there was a higher rate of CD among women with expectant management beyond 38 weeks (adjusted odds ratio [AOR] 1.80; 95{\%} CI 1.29-2.53), 39 weeks (1.39; 95{\%} CI 1.08-1.80), and 40 weeks (AOR 1.27; 95{\%} CI 1.00-1.62). Conclusion: Our findings suggest that IOL may not increase a woman's risk of CD when compared to expectant management. While this question has been addressed prospectively at 41 weeks gestation, it requires further examination at earlier gestations and among various subgroups.",
keywords = "Cesarean delivery, gestational age, perinatal epidemiology, Labor induction",
author = "Aaron Caughey and Nicholson, {James M.} and Cheng, {Yvonne W.} and Lyell, {Deirdre J.} and Washington, {A. Eugene}",
year = "2006",
month = "9",
doi = "10.1016/j.ajog.2006.07.003",
language = "English (US)",
volume = "195",
pages = "700--705",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Induction of labor and cesarean delivery by gestational age

AU - Caughey, Aaron

AU - Nicholson, James M.

AU - Cheng, Yvonne W.

AU - Lyell, Deirdre J.

AU - Washington, A. Eugene

PY - 2006/9

Y1 - 2006/9

N2 - Objective: Studies of cesarean delivery (CD) rates among women undergoing induction of labor (IOL) often compare such women to women experiencing spontaneous labor at similar gestational ages. We sought to examine the association between IOL at various gestational ages and CD, accounting for the effect of increased gestational age among the comparison group who were managed expectantly. Study design: We conducted a retrospective cohort study of all term, singleton, cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor. For each gestational age of induction, we created a comparison group of women who were undelivered at that gestational age, and who experienced labor at some future gestational age. Results: In women undergoing IOL at 38 weeks gestation, the CD rate was 11.9% as compared to 13.3% (P = .42) of women beyond 38 weeks gestation. The CD rate for induction of labor compared to ongoing pregnancy was 14.3% versus 15.0% (P = .62) at 39 weeks, 20.4% versus 19.0% (P = .41) at 40 weeks, and 24.3% versus 26.0% (P = .39) at 41 weeks. When controlling for potential confounding, there was a higher rate of CD among women with expectant management beyond 38 weeks (adjusted odds ratio [AOR] 1.80; 95% CI 1.29-2.53), 39 weeks (1.39; 95% CI 1.08-1.80), and 40 weeks (AOR 1.27; 95% CI 1.00-1.62). Conclusion: Our findings suggest that IOL may not increase a woman's risk of CD when compared to expectant management. While this question has been addressed prospectively at 41 weeks gestation, it requires further examination at earlier gestations and among various subgroups.

AB - Objective: Studies of cesarean delivery (CD) rates among women undergoing induction of labor (IOL) often compare such women to women experiencing spontaneous labor at similar gestational ages. We sought to examine the association between IOL at various gestational ages and CD, accounting for the effect of increased gestational age among the comparison group who were managed expectantly. Study design: We conducted a retrospective cohort study of all term, singleton, cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor. For each gestational age of induction, we created a comparison group of women who were undelivered at that gestational age, and who experienced labor at some future gestational age. Results: In women undergoing IOL at 38 weeks gestation, the CD rate was 11.9% as compared to 13.3% (P = .42) of women beyond 38 weeks gestation. The CD rate for induction of labor compared to ongoing pregnancy was 14.3% versus 15.0% (P = .62) at 39 weeks, 20.4% versus 19.0% (P = .41) at 40 weeks, and 24.3% versus 26.0% (P = .39) at 41 weeks. When controlling for potential confounding, there was a higher rate of CD among women with expectant management beyond 38 weeks (adjusted odds ratio [AOR] 1.80; 95% CI 1.29-2.53), 39 weeks (1.39; 95% CI 1.08-1.80), and 40 weeks (AOR 1.27; 95% CI 1.00-1.62). Conclusion: Our findings suggest that IOL may not increase a woman's risk of CD when compared to expectant management. While this question has been addressed prospectively at 41 weeks gestation, it requires further examination at earlier gestations and among various subgroups.

KW - Cesarean delivery, gestational age, perinatal epidemiology

KW - Labor induction

UR - http://www.scopus.com/inward/record.url?scp=33747873265&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33747873265&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2006.07.003

DO - 10.1016/j.ajog.2006.07.003

M3 - Article

C2 - 16949399

AN - SCOPUS:33747873265

VL - 195

SP - 700

EP - 705

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 3

ER -