Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women

Stephen M. Wagner; Grecio Sandoval; William A. Grobman; Jennifer L. Bailit; Ronald J. Wapner; Michael W. Varner; John M. Thorp; Mona Prasad; Alan T.N. Tita; George R. Saade; Yoram Sorokin; Dwight J. Rouse; Jorge E. Tolosa

doi:10.1055/s-0040-1716711

Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women

Stephen M. Wagner, Grecio Sandoval, William A. Grobman, Jennifer L. Bailit, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Mona Prasad, Alan T.N. Tita, George R. Saade, Yoram Sorokin, Dwight J. Rouse, Jorge E. Tolosa

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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 ≥39 ^0/7weeks. Women who electively induced between 39 ^0/7and 39 ^6/7weeks were compared with women who expectantly managed ≥39 ^0/7weeks. 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.

Original language	English (US)
Pages (from-to)	519-525
Number of pages	7
Journal	American journal of perinatology
Volume	39
Issue number	5
DOIs	https://doi.org/10.1055/s-0040-1716711
State	Published - Apr 1 2022

Keywords

cesarean delivery
elective induction
maternal morbidity
parous pregnancy

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

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10.1055/s-0040-1716711

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Wagner, S. M., Sandoval, G., Grobman, W. A., Bailit, J. L., Wapner, R. J., Varner, M. W., Thorp, J. M., Prasad, M., Tita, A. T. N., Saade, G. R., Sorokin, Y., Rouse, D. J., & Tolosa, J. E. (2022). Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women. American journal of perinatology, 39(5), 519-525. https://doi.org/10.1055/s-0040-1716711

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title = "Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women",

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 ≥39 0/7weeks. Women who electively induced between 39 0/7and 39 6/7weeks were compared with women who expectantly managed ≥39 0/7weeks. 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.",

keywords = "cesarean delivery, elective induction, maternal morbidity, parous pregnancy",

author = "Wagner, {Stephen M.} and Grecio Sandoval and Grobman, {William A.} and Bailit, {Jennifer L.} and Wapner, {Ronald J.} and Varner, {Michael W.} and Thorp, {John M.} and Mona Prasad and Tita, {Alan T.N.} and Saade, {George R.} and Yoram Sorokin and Rouse, {Dwight J.} and Tolosa, {Jorge E.}",

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doi = "10.1055/s-0040-1716711",

language = "English (US)",

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TY - JOUR

T1 - Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women

AU - Wagner, Stephen M.

AU - Sandoval, Grecio

AU - Grobman, William A.

AU - Bailit, Jennifer L.

AU - Wapner, Ronald J.

AU - Varner, Michael W.

AU - Thorp, John M.

AU - Prasad, Mona

AU - Tita, Alan T.N.

AU - Saade, George R.

AU - Sorokin, Yoram

AU - Rouse, Dwight J.

AU - Tolosa, Jorge E.

PY - 2022/4/1

Y1 - 2022/4/1

N2 - 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 ≥39 0/7weeks. Women who electively induced between 39 0/7and 39 6/7weeks were compared with women who expectantly managed ≥39 0/7weeks. 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.

AB - 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 ≥39 0/7weeks. Women who electively induced between 39 0/7and 39 6/7weeks were compared with women who expectantly managed ≥39 0/7weeks. 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.

KW - cesarean delivery

KW - elective induction

KW - maternal morbidity

KW - parous pregnancy

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JF - American journal of perinatology

IS - 5

ER -

Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women

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