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Created on : 25 Jul 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Outcome after elective labor induction in nulliparous women: a matched cohort study. Am J Obstet Gynecol 2002, 186:240–244.

Author(s) :

Cammu H, Martens G, Ruyssinck G, Amy J

Year of publication :

2002

URL(s) :

http://www.biomedcentral.com/content/pdf/cr-wr312c…

Résumé (français)  :

Abstract (English)  :

Introduction: Labor induction is considered elective when it is undertaken for the purpose of convenience and in the absence of any maternal or fetal condition that justifies delivery. The elective labor induction is commonly practiced in Flanders (North Belgium). From 1996 to 1997, 30% of all deliveries were induced, of which 71% were elective. Therefore, 1 in 5 pregnant woman in Flanders had a labor induction for convenience. The outcome of elective induction compared with labor of spontaneous onset has not been extensively studied.

Aims: The study was designed to determine whether the current practice of elective labor induction in Flanders was associated with differences in mode of delivery, demand for pain relief, and need for neonatal care when compared with labor of spontaneous onset.

Methods: During the study, from January 1, 1996, through December 31, 1997, 124,680 deliveries took place in Flanders. Labor was induced in 30% of the deliveries, and elective labor induction took place in 21% of the deliveries. Of the deliveries, 46% were nulliparous; 14.3%were cesarean deliveries; 13.2% were instrumental deliveries; 53% required epidural analgesia; 16.8% were transferred to the neonatal ward; and 1.7% of infants had congenital malformations. The perinatal mortality rate was 0.7%. The inclusion criteria for the woman with electively induced labor and those with a labor of spontaneous onset were as follows: nulliparous woman with a low-risk, singleton pregnancy in cephalic presentation, and delivery of a liveborn infant. Both study groups were matched for maternal age, gestational age (between 266 and 287 dy), birth weight (between 3000 and 4000 g), and gender of the infant. There were 7683 cases of electively induced labor and 7683 cases of spontaneous labor selected as controls. The variables studied included: incidence of cesarean delivery, instrumental delivery, epidural analgesia, transfer to the neonatal ward, congenital malformations, and neonatal death. The nonparametric Mann-Whitney U test was used for comparing the induction rates in the hospitals with a different level of specialization. Chi-square tests were used to evaluate the association between discrete variables. The relative risks were given together with their 95% confidence intervals to measure the strength of these associations.

Results: Elective labor induction was most frequently performed in the four university hospitals (mean, 25%) followed by the teaching hospitals (mean, 23%). The induction ratio in the peripheral hospitals amounted to 20% (P < 0.001 Mann-Whitney U test). Induced labor was associated with significantly more cesarean deliveries (9.9% versus 6.5%) and slightly, but significantly, more instrumental deliveries. The increased frequency of cesarean delivery in induced labor was predominantly the result of higher incidence of first-stage dystocia (5.9% versus 3.3%). Fetal distress as a reason for cesarean delivery was more frequently encountered when labor had been electively induced (2.6% versus 1.8%). Babies who were born after induced labor were transferred more often to the neonatal ward (10.7% versus 9.4%). The epidural analgesia was utilized more often in the elective induction group (79.8% versus 57.6%).

Sumário (português)  :

Resumen (español)  :

Comments :

Argument (français) :

Le déclenchement de convenance entraîne un taux significativement plus important de césariennes, et légèrement plus élevé d’extractions instrumentales.

Argument (English):

(Elective) induced labor is associated with significantly more cesarean deliveries and slightly, but significantly, more instrumental deliveries.

Argumento (português):

Argumento (español):

Keywords :

➡ c-section/caesarean ; physiology ; induction of labor ; maternal age ; post-term pregnancy

Author of this record :

Bernard Bel — 25 Jul 2004