Decision Aid to Assist Low-Risk Nulliparous Women Considering Induction of Labor At 39 Weeks

Abstract Background: To investigate the effect of induction of labor on maternal and fetal outcomes. Methods: This retrospective case-control study included 4386 pregnant women with low-risk singleton pregnancies who underwent regular prenatal examination and successful vaginal delivery at ≥41 weeks and 0 days of gestation in Fujian Maternal and Child Health Hospital between January 2014 and December 2018. Clinical data were reviewed according to the mode of labor initiation; the women were divided into an induction of labor group (2007 cases) and a spontaneous onset of labor group (2361 cases). Two-sample independent t-test and χ 2 tests were used to analyze the differences in clinical characteristics such as maternal age and parity between the two groups. Results: The induction of labor group had a significantly longer total duration of labor (9.37±5.37 vs. 8.82±5.13 h; P<0.001), was associated with more postpartum blood loss (219.18±188.32 vs. 199.95±124.69 mL; P=0.01), and had a significantly higher incidence of severe postpartum hemorrhage (PPH) (0.8% [16/2007] vs. 0.33% [8/2361]; P=0.041) than the spontaneous onset of labor group. However, no significant difference was found in the neonatal outcomes. After adjusting for age, induction of labor in nulliparous women was more likely to lead to PPH than spontaneous onset of labor (2.74% [55/2007] vs. 1.65% [39/2361]; odds ratio=1.557; 95% confidence interval: 1.039–2.332; P<0.05]. Conclusion: Induction of labor increases postpartum blood loss, especially in primary parturients, leading to an increased risk of PPH, which may be related to the prolongation of the total duration of labor. Therefore, low-risk nulliparous women should try to avoid induction of labor without medical indications.

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Term Labor Induction and Cesarean Delivery Risk among Obese Women with and without Comorbidities

American Journal of Perinatology ◽

10.1055/s-0040-1714422 ◽

2020 ◽

Author(s):

Kimberly B. Glazer ◽

Valery A. Danilack ◽

Alison E. Field ◽

Erika F. Werner ◽

David A. Savitz

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Maternal Age ◽

Expectant Management ◽

Labor Induction ◽

Induction Of Labor ◽

Low Risk ◽

Obese Women ◽

Adjusted Risk ◽

Nulliparous Women

Objective Findings of the recent ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, showing reduced cesarean risk with elective labor induction among low-risk nulliparous women at 39 weeks' gestation, have the potential to change interventional delivery practices but require examination in wider populations. The aim of this study was to identify whether term induction of labor was associated with reduced cesarean delivery risk among women with obesity, evaluating several maternal characteristics associated with obesity, induction, and cesarean risk. Study Design We studied administrative records for 66,280 singleton, term births to women with a body mass index ≥30, without a prior cesarean delivery, in New York City from 2008 to 2013. We examined elective inductions in 39 and 40 weeks' gestation and calculated adjusted risk ratios for cesarean delivery risk, stratified by parity and maternal age. We additionally evaluated medically indicated inductions at 37 to 40 weeks among women with obesity and diabetic or hypertensive disorders, comorbidities that are strongly associated with obesity. Results Elective induction of labor was associated with a 25% (95% confidence interval: 19–30%) lower adjusted risk of cesarean delivery as compared with expectant management at 39 weeks of gestation and no change in risk at 40 weeks. Patterns were similar when stratified by parity and maternal age. Risk reductions in week 39 were largest among women with a prior vaginal delivery. Women with comorbidities had reduced cesarean risk with early term induction and in 39 weeks. Conclusion Labor induction at 39 weeks was consistently associated with reduced risk of cesarean delivery among women with obesity regardless of parity, age, or comorbidity status. Cesarean delivery findings from induction trials at 39 weeks among low-risk nulliparous women may generalize more broadly across the U.S. obstetric population, with potentially larger benefit among women with a prior vaginal delivery. Key Points

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