Impending macrosomia: Will induction of labour modify the risk of caesarean delivery?

Y. W. Cheng, T. N. Sparks, R. K. Laros, James Nicholson, A. B. Caughey

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective: To compare the annual incidence rates of caesarean delivery between induction of labour and expectant management in the setting of macrosomia. Design This is a retrospective cohort study. Setting Deliveries in the USA in 2003. Population Singleton births of macrosomic neonates to low-risk nulliparous women at 39 weeks of gestation and beyond. Methods Women who had induction of labour at 39 weeks of gestation with a neonatal birthweight of 4000 ± 125 g (3875-4125 g) were compared with women who delivered (either induced or spontaneous labour) at 40, 41 or 42 weeks (i.e. expectant management), assuming an intrauterine fetal weight gain of 200 g per additional week of gestation. Similar comparisons were made at 40 and 41 weeks of gestation. Chi-square test and multivariable logistic regression analysis were used for statistical comparison. Main outcome measures Method of delivery, 5-minute Apgar scores, neonatal injury. Results There were 132 112 women meeting the study criteria. In women whose labours were induced at 39 weeks and who delivered a neonate with a birthweight of 4000 ± 125 g, the frequency of caesarean was lower compared with women who delivered at a later gestational age (35.2% versus 40.9%; adjusted OR 1.25, 95% CI 1.17-1.33). This trend was maintained at both 40 weeks (36.1% versus 42.6%; adjusted OR 1.31, 95% CI 1.23-1.40) and 41 weeks (38.9% versus 41.8%; adjusted OR 1.16, 95% CI 1.06-1.28) of gestation. Conclusions In the setting of known birthweight, it appears that induction of labour may reduce the risk of caesarean delivery. Future research should concentrate on clinical and radiological methods to better estimate birthweight to facilitate improved clinical care. These findings deserve examination in a large, prospective, randomised trial.

Original languageEnglish (US)
Pages (from-to)402-409
Number of pages8
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume119
Issue number4
DOIs
StatePublished - Jan 1 2012

Fingerprint

Induced Labor
Pregnancy
Newborn Infant
Fetal Weight
Apgar Score
Chi-Square Distribution
Gestational Age
Weight Gain
Cohort Studies
Retrospective Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Parturition
Incidence
Wounds and Injuries
Population

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Cheng, Y. W. ; Sparks, T. N. ; Laros, R. K. ; Nicholson, James ; Caughey, A. B. / Impending macrosomia : Will induction of labour modify the risk of caesarean delivery?. In: BJOG: An International Journal of Obstetrics and Gynaecology. 2012 ; Vol. 119, No. 4. pp. 402-409.
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Impending macrosomia : Will induction of labour modify the risk of caesarean delivery? / Cheng, Y. W.; Sparks, T. N.; Laros, R. K.; Nicholson, James; Caughey, A. B.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 119, No. 4, 01.01.2012, p. 402-409.

Research output: Contribution to journalArticle

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N2 - Objective: To compare the annual incidence rates of caesarean delivery between induction of labour and expectant management in the setting of macrosomia. Design This is a retrospective cohort study. Setting Deliveries in the USA in 2003. Population Singleton births of macrosomic neonates to low-risk nulliparous women at 39 weeks of gestation and beyond. Methods Women who had induction of labour at 39 weeks of gestation with a neonatal birthweight of 4000 ± 125 g (3875-4125 g) were compared with women who delivered (either induced or spontaneous labour) at 40, 41 or 42 weeks (i.e. expectant management), assuming an intrauterine fetal weight gain of 200 g per additional week of gestation. Similar comparisons were made at 40 and 41 weeks of gestation. Chi-square test and multivariable logistic regression analysis were used for statistical comparison. Main outcome measures Method of delivery, 5-minute Apgar scores, neonatal injury. Results There were 132 112 women meeting the study criteria. In women whose labours were induced at 39 weeks and who delivered a neonate with a birthweight of 4000 ± 125 g, the frequency of caesarean was lower compared with women who delivered at a later gestational age (35.2% versus 40.9%; adjusted OR 1.25, 95% CI 1.17-1.33). This trend was maintained at both 40 weeks (36.1% versus 42.6%; adjusted OR 1.31, 95% CI 1.23-1.40) and 41 weeks (38.9% versus 41.8%; adjusted OR 1.16, 95% CI 1.06-1.28) of gestation. Conclusions In the setting of known birthweight, it appears that induction of labour may reduce the risk of caesarean delivery. Future research should concentrate on clinical and radiological methods to better estimate birthweight to facilitate improved clinical care. These findings deserve examination in a large, prospective, randomised trial.

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