February 12th, 2016

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Maternal and Neonatal Morbidity Among Nulliparous Women Undergoing Elective Induction of Labor
Authors:  J. H. Vardo, D.O., L. L. Thornburg, M.D., and J. C. Glantz, M.D., M.P.H.
  OBJECTIVE: To determine rates of adverse maternal and neonatal outcomes among nulliparous women undergoing elective labor induction compared with spontaneous labor.

STUDY DESIGN: Retrospective chart review of term, nulliparous women with singleton gestations in 2007. Elective induction was defined as induction occurring from 370/7 to 410/7 weeks without ruptured membranes, fetal/maternal complications, or abnormal fetal testing. The primary outcome was cesarean delivery; secondary outcomes were maternal and fetal complications. Continuous variables were compared with t test and Mann-Whitney U, categorical with c2 and Fisher’s exact test. Logististic and linear regression were used to control for confounders and to assess independent effects of induction.

RESULTS: Of 850 nulliparous, singleton, term deliveries, 485 met criteria for inclusion. Cesarean delivery rate was 19.8% in the labor group and 33.6% in the induction group (p=0.002). Odds ratio for cesarean was 2.1 (p=0.001), 1.8 after adjustment for gestational age and birth weight, (p=0.01). Length of stay (LOS) was significantly associated with induction even after adjustment for cesarean (b=0.7, p<0.001). Rates of epidural, postpartum hemorrhage, pediatric delivery attendance and neonatal oxygen requirement were higher with induction, before and after adjustment (p<0.05).

CONCLUSION: Elective induction of labor in nulliparas is associated with increased rates of cesarean, postpartum hemorrhage, neonatal resuscitation and longer LOS without improvement in neonatal outcomes.
Keywords:  cesarean section; induction of labor, elective; morbidity; nulliparous
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