Induction of labor: does indication matter?

Abstract

PURPOSE:

Labor induction is performed in 20 % of pregnancies. However, the impact of the indications for induction on its failure rate has hardly been investigated. We aimed to evaluate the association of indications for labor induction with failure rate.

METHODS:

Background and delivery-related data were retrospectively collected for all women with a viable term singleton pregnancy, who underwent labor induction with a PGE2 vaginal insert in 2013-2014. Reasons for induction were categorized as maternal indications, hypertensive disorders, premature rupture of membranes, and fetal indications. Induction failure was defined as Bishop score ≤7 at 24 h after PGE2 administration, cesarean delivery due to latent phase dystocia or removal of the insert due to non-reassuring fetal heart rate followed by emergency cesarean delivery. Outcome measures were rate of induction failure (primary) and rate of cesarean delivery (secondary).

RESULTS:

The cohort included 1066 women. Those who failed induction (n = 213, 20 %) were more likely to be nulliparous (69.5 vs. 45.7 %, p < 0.0001), older (31 vs. 30 years, p = 0.047), and at an earlier gestational age (39.4 vs. 40.0 weeks, p < 0.0001). Among nulliparous women, maternal indications were significantly associated with induction failure (aOR 2.52, 95 % CI 1.28-4.95, p = 0.007) and cesarean delivery (aOR 2.36, 95 % CI 0.40-2.29, p = 0.019). Among multiparous women, hypertensive disorders (aOR 7.26, 95 % CI 1.89-27.87, p = 0.004) and maternal indications (aOR 4.22, 95 %CI 1.14-15.58, p = 0.031) were significantly associated with induction failure but not cesarean delivery.

CONCLUSIONS:

The indication for induction of labor may impact its failure rate.

• Authors: Rinat Gabbay-Benziv, Eran Hadar, Eran Ashwal, Rony Chen, Arnon Wiznitzer, Liran Hiersch
• Journal: Archives of gynecology and obstetrics (Arch Gynecol Obstet) Vol. 294 Issue 6 Pg. 1195-1201 (11 2016) ISSN: 1432-0711 [Electronic] Germany
• PMID: 27501927 (Publication Type: Journal Article)

Topics

• Adult
• Cesarean Section (methods)
• Cohort Studies
• Female
• Humans
• Labor, Induced (methods)
• Pregnancy
• Pregnancy Outcome
• Retrospective Studies