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https://ciane.net/id=882

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

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Bibliographical entry (without author) :

U.S. National Trends in Labor Induction, 1989–1999. J Reprod Med 2002, 47:120–124.

Author(s) :

Zhang J, Yancy MK, Henderson C

Year of publication :

2002

URL(s) :

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

Résumé (français)  :

Abstract (English)  :

Methods: This study was based on the data from the National Center for Health Statistics during the years 1989 to 1999. The study analyzed several variables in nulliparous and multiparous patients.

Results: Between 1990 and 1998, the rate of labor induction increased from 9.5% to 19.4% of all births nationwide. White woman were more likely to have induced labor in comparison with those of other races (20.6% versus 14%). Maternal age had little impact, except in the very young age group, in whom induction of labor was less common. Nulliparas had a higher rate than multiparas. The rate of labor induction for complicated pregnancies increased substantially, especially for those with renal diseases during pregnancy and those who had previously given birth to an infant who weighed less than 4000 g. The induction rate for pregnancies with an abruptio placentae, breech presentation, and multi-fetal pregnancy remained low during the study period; however, the rate increased significantly. The induction rate increased with education and earlier initiation of prenatal care.

Based on these findings, the authors conclude that given the increasing popularity of elective induction of labor, even a small risk of cesarean delivery in nullipara may translate into a large number of cesarean deliveries in excess nationwide. Considering the direct financial costs, potential increase in maternal morbidity, and likelihood of repeat cesarean delivery in subsequent pregnancies, the convenience of elective induction of labor bears a stiff price.

Editor’s comments

Based on this study, there is no question that elective induction of labor is becoming much more common. The rate of elective induction of labor has doubled in the past 10 years and is expected to reach 30% by the year 2007. The cause for an increased rate of elective induction of labor is most likely due to increased fetal surveillance, improvements in neonatal care, improvements in cervical ripening agents, and increased number of patients with medical risks (due to older maternal age, reproductive technologies). However, the article states that the increase in indicated induction was significantly smaller than the overall increase (70% versus 100% increase), which suggests that the rate of elective induction has risen much more rapidly. The use of pre-induction diagnoses such as impending macrosomatia and impending pregnancyinduced hypertension, and induction for patient or physician convenience have impacted this rate of growth. We should begin to study and review our methods of practice regarding elective inductions because long-term ramifications of cesarean sections and more complicated pregnancy outcomes might result, specifically for the nulliparous patient.

Experienced obstetricians know from years of practice that an elective induction of labor in a multiparous patient with a ripe cervix is completely different from induction in a nulliparous patient with an unripe cervix. Most likely, the answer for the future is to become more stringent with guidelines in the primiparous patient and less concerned with the multiparous patient with a ripe cervix.

Sumário (português)  :

Resumen (español)  :

Comments :

Argument (français) :

Etant donnée la popularité croissante des déclenchements d’accouchements, même un faible risque de césarienne pour les nullipares peut se traduire à l’échelle du pays par une augmentation importante du nombre d’accouchements en césarienne.

Argument (English):

Given the increasing popularity of elective induction of labor, even a small risk of cesarean delivery in nullipara may translate into a large number of cesarean deliveries in excess nationwide.

Argumento (português):

Argumento (español):

Keywords :

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

Author of this record :

Bernard Bel — 25 Jul 2004