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DOI: 10.1055/s-0039-1701025
Quantifying the Risks and Benefits of Continuing Labor Induction: Data for Shared Decision-Making
Funding S.L.G. was supported by the National Institutes of Health (NIAID K08AI141728).![](https://www.thieme-connect.de/media/ajp/202109/lookinside/thumbnails/10-1055-s-0039-1701025_190562-1.jpg)
Abstract
Objective This study aimed to quantify the relative maternal and fetal risks and benefits of continuing labor induction.
Study Design This retrospective cohort study included nulliparous women with nonanomalous, singleton, vertex, term pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. The primary outcome was mode of delivery. Secondary outcomes included hemorrhage, transfusion, infection, and composite neonatal morbidity. The data were analyzed using chi-square and Fisher's exact tests. Multivariable regression was used to control for potential confounders.
Results A total of 955 patients met the inclusion criteria. The median induction duration was 32.3 hours (interquartile range: 20.4–41 hours) and the vaginal delivery rate was 70.5% (n = 673). The chance of vaginal delivery at 12, 24, 36, 48, 60, and ≥60 hours was 76, 83, 77, 74, 72, and 48%, respectively. After controlling for confounders, there was a 20% decrease in chance of vaginal delivery with induction ≥ 24 hours compared with induction < 24 hours. The adjusted relative risks of hemorrhage, transfusion, and infection with induction ≥ 24 hours compared with induction < 24 hours were 1.9, 2.2, and 2.7, respectively (95% confidence interval [CI] of 1.4–2.5, 1.1–3.9, and 1.8–4.0, respectively). The relative risk for these outcomes remained stable or decreased at each subsequent time point. The increasing risks of hemorrhage and infection were primarily among patients who underwent cesarean delivery. There was no association between induction duration and neonatal morbidity.
Conclusion In this cohort, the chance of vaginal delivery remained nearly 50% even when induction extended beyond 60 hours. Risks of hemorrhage and maternal infection rose modestly over time, but primarily in patients who underwent cesarean delivery. There was no difference in the risk of transfusion beyond 24 hours and no association between induction duration and neonatal morbidity. These findings may be useful when engaging patients in shared decision-making during labor induction.
Keywords
induction of labor - labor induction duration - prolonged IOL - obstetrics - outcomes - perinatal outcomes - pregnancy - shared decision-makingNote
The relative risks of continuing a labor induction up to 60 hours are modest and should be weighed against the benefits of potential VD.
Publikationsverlauf
Eingereicht: 16. September 2019
Angenommen: 10. Dezember 2019
Artikel online veröffentlicht:
03. Februar 2020
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References
- 1 ACOG Committee Opinion No. ACOG Committee Opinion No. 764: medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2019; 133 (02) e151-e155
- 2 Grobman WA, Rice MM, Reddy UM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
- 3 Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington AE. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol 2006; 195 (03) 700-705
- 4 Caughey AB. The safe prevention of the primary cesarean. Clin Obstet Gynecol 2015; 58 (02) 207-210
- 5 Simon CE, Grobman WA. When has an induction failed?. Obstet Gynecol 2005; 105 (04) 705-709
- 6 Rouse DJ, Weiner SJ, Bloom SL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Failed labor induction: toward an objective diagnosis. Obstet Gynecol 2011; 117 (2 Pt 1): 267-272
- 7 Grobman WA, Bailit J, Lai Y. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Defining failed induction of labor. Am J Obstet Gynecol 2018; 218 (01) 122.e1-122.e8
- 8 Triebwasser JE, VanArtsdalen J, Kobernik EK, Seiler K, Langen ES. Assessing maternal and fetal risks associated with prolonged induction of labor. Am J Perinatol 2019; 36 (05) 455-459
- 9 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186