Labor induction and cesarean delivery

A prospective cohort study of first births in Pennsylvania, USA

Kristen Kjerulff, Laura B. Attanasio, Joyce K. Edmonds, Katy B. Kozhimannil, John Repke

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery. Methods: A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009-2011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery—the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors—including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor. Results: More than a third of the women were induced (34.3%) and 24.8% underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9%) than women in spontaneous labor (18.9%), unadjusted OR 2.35 (95% CI 1.97-2.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7% of this association), particularly cervical dilatation <3 cm at hospital admission, fetal intolerance of labor, and dystocia. The indications for labor induction only explained 6.2%. Conclusions: Increased risk of cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications.

Original languageEnglish (US)
Pages (from-to)252-261
Number of pages10
JournalBirth
Volume44
Issue number3
DOIs
StatePublished - Sep 1 2017

Fingerprint

Induced Labor
Birth Order
Cohort Studies
Prospective Studies
First Labor Stage
Dystocia
Parturition
Logistic Models
Obstetric Labor Complications
Mothers
Epidural Analgesia
Pregnancy

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Kjerulff, Kristen ; Attanasio, Laura B. ; Edmonds, Joyce K. ; Kozhimannil, Katy B. ; Repke, John. / Labor induction and cesarean delivery : A prospective cohort study of first births in Pennsylvania, USA. In: Birth. 2017 ; Vol. 44, No. 3. pp. 252-261.
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abstract = "Background: Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery. Methods: A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009-2011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery—the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors—including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor. Results: More than a third of the women were induced (34.3{\%}) and 24.8{\%} underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9{\%}) than women in spontaneous labor (18.9{\%}), unadjusted OR 2.35 (95{\%} CI 1.97-2.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7{\%} of this association), particularly cervical dilatation <3 cm at hospital admission, fetal intolerance of labor, and dystocia. The indications for labor induction only explained 6.2{\%}. Conclusions: Increased risk of cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications.",
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Labor induction and cesarean delivery : A prospective cohort study of first births in Pennsylvania, USA. / Kjerulff, Kristen; Attanasio, Laura B.; Edmonds, Joyce K.; Kozhimannil, Katy B.; Repke, John.

In: Birth, Vol. 44, No. 3, 01.09.2017, p. 252-261.

Research output: Contribution to journalArticle

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T1 - Labor induction and cesarean delivery

T2 - A prospective cohort study of first births in Pennsylvania, USA

AU - Kjerulff, Kristen

AU - Attanasio, Laura B.

AU - Edmonds, Joyce K.

AU - Kozhimannil, Katy B.

AU - Repke, John

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