Labor Induction in contemporary obstetric cohort: 46.6% of nulliparas and 41% of multips, increase in CS done during latent phase of labor

by faithgibson on July 13, 2013

in Contemporary Childbirth Politics, Economic Issue$

American Journal of Obstetrics & Gynecology

JUNE 2012 ~ Research Obstetrics ~  www.AJOG.org

Induction of labor in a contemporary obstetric cohort

Quotes of interest:

Induction of labor was a common obstetric intervention, occurring in 47.6% of nulliparous and 41.0% of multiparous women attempting vaginal delivery.

…. elective induction and induction with no recorded indication occurred in about one-third of nulliparas and almost half of multiparas at term.

…. cesarean delivery in the first stage of labor was more common in nulliparas < 6 cm.

Women at term with induction for elective reasons or with no recorded indication had an associated 24% rate of cesarean delivery, with the majority performed in latent labor.

COMMENT Section: Considering the findings that nullipa- rous women at term with induction for elective reasons or with no recorded in- dication had an associated 24% rate of cesarean delivery, with the majority per- formed in latent labor, selecting appro- priate candidates, avoiding elective in- duction in nulliparas, especially with an unripe cervix, and waiting longer for labor to progress into the active phase (>6 cm) would make an impact on decreasing the national cesarean delivery rate.

S. Katherine Laughon, MD, MS; Jun Zhang, PhD, MD; Jagteshwar Grewal, PhD; Rajeshwari Sundaram, PhD; Julie Beaver, MS; Uma M. Reddy, MD, MPH

OBJECTIVE: We sought to describe details of labor induction, including precursors and methods, and associated vaginal delivery rates.

STUDY DESIGN: This was a retrospective cohort study of 208,695 electronic medical records from 19 hospitals across the United States, 2002 through 2008.

RESULTS (these number only apply to the study cohort): Induction occurred in 42.9% of nulliparas and 31.8% of multiparas: 

Elective or no recorded indication for induction at term occurred in 35.5% and 44.1%, respectively.

Elective induction at term in multiparas was highly successful (vaginal delivery 97%) compared to nulliparas (76.2%).

For all precursors, cesarean delivery was more common in nulliparas in the latent compared to active phase of labor.

Regardless of method, vaginal delivery rates were higher with a ripe vs unripe cervix, particularly for multiparas (86.6-100%).

CONCLUSION: Induction of labor was a common obstetric intervention. Selecting appropriate candidates and waiting longer for labor to prog- ress into the active phase would make an impact on decreasing the na- tional cesarean delivery rate.

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Cite this article as: Laughon SK, Zhang J, Grewal J, et al. Induction of labor in a contemporary obstetric cohort. Am J Obstet Gynecol 2012;206:486.e1-9. 

 

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