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

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

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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 1 2013

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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

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Darney, B. G., Snowden, J. M., Cheng, Y. W., Jacob, L., Nicholson, J., Kaimal, A., ... Caughey, A. B. (2013). Elective induction of labor at term compared with expectant management: Maternal and neonatal outcomes. Obstetrics and Gynecology, 122(4), 761-769. https://doi.org/10.1097/AOG.0b013e3182a6a4d0
Darney, Blair G. ; Snowden, Jonathan M. ; Cheng, Yvonne W. ; Jacob, Lorie ; Nicholson, James ; Kaimal, Anjali ; Dublin, Sascha ; Getahun, Darios ; Caughey, Aaron B. / 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.
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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.",
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Darney, BG, Snowden, JM, Cheng, YW, Jacob, L, Nicholson, J, Kaimal, A, Dublin, S, Getahun, D & Caughey, AB 2013, 'Elective induction of labor at term compared with expectant management: Maternal and neonatal outcomes', Obstetrics and Gynecology, vol. 122, no. 4, pp. 761-769. https://doi.org/10.1097/AOG.0b013e3182a6a4d0

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

In: Obstetrics and Gynecology, Vol. 122, No. 4, 01.10.2013, p. 761-769.

Research output: Contribution to journalArticle

TY - JOUR

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

T2 - Maternal and neonatal outcomes

AU - Darney, Blair G.

AU - Snowden, Jonathan M.

AU - Cheng, Yvonne W.

AU - Jacob, Lorie

AU - Nicholson, James

AU - Kaimal, Anjali

AU - Dublin, Sascha

AU - Getahun, Darios

AU - Caughey, Aaron B.

PY - 2013/10/1

Y1 - 2013/10/1

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.

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