[show abstract][hide abstract] ABSTRACT: There is evidence that induction of labour (IOL) around term reduces perinatal mortality and caesarean delivery rates when compared to expectant management of pregnancy (allowing the pregnancy to continue to await spontaneous labour or definitive indication for delivery). However, it is not clear whether IOL in women with a previous caesarean section confers the same benefits. The aim of this study was to describe outcomes of IOL at 39-41 weeks in women with one previous caesarean delivery and to compare outcomes of IOL or planned caesarean delivery to those of expectant management.
We performed a population-based retrospective cohort study of singleton births greater than 39 weeks gestation, in women with one previous caesarean delivery, in Scotland, UK 1981-2007 (n = 46,176). Outcomes included mode of delivery, perinatal mortality, neonatal unit admission, postpartum hemorrhage and uterine rupture. 40.1% (2,969/7,401) of women who underwent IOL 39-41 weeks were ultimately delivered by caesarean. When compared to expectant management IOL was associated with lower odds of caesarean delivery (adjusted odds ratio [AOR] after IOL at 39 weeks of 0.81 [95% CI 0.71-0.91]). There was no significant effect on the odds of perinatal mortality but greater odds of neonatal unit admission (AOR after IOL at 39 weeks of 1.29 [95% CI 1.08-1.55]). In contrast, when compared with expectant management, elective repeat caesarean delivery was associated with lower perinatal mortality (AOR after planned caesarean at 39 weeks of 0.23 [95% CI 0.07-0.75]) and, depending on gestation, the same or lower neonatal unit admission (AOR after planned caesarean at 39 weeks of 0.98 [0.90-1.07] at 40 weeks of 1.08 [0.94-1.23] and at 41 weeks of 0.77 [0.60-1.00]).
A more liberal policy of IOL in women with previous caesarean delivery may reduce repeat caesarean delivery, but increases the risks of neonatal complications.
PLoS ONE 01/2013; 8(4):e60404. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine neonatal outcomes (perinatal mortality and special care unit admission) and maternal outcomes (mode of delivery, delivery complications) of elective induction of labour compared with expectant management.
Retrospective cohort study using an unselected population database.
Consultant and midwife led obstetric units in Scotland 1981-2007.
1,271,549 women with singleton pregnancies of 37 weeks or more gestation.
Outcomes of elective induction of labour (induction of labour with no recognised medical indication) at 37, 38, 39, 40, and 41 weeks' gestation compared with those of expectant management (continuation of pregnancy to either spontaneous labour, induction of labour or caesarean section at a later gestation).
Extended perinatal mortality, mode of delivery, postpartum haemorrhage, obstetric anal sphincter injury, and admission to a neonatal or special care baby unit. Outcomes were adjusted for age at delivery, parity, year of birth, birth weight, deprivation category, and, where appropriate, mode of delivery.
At each gestation between 37 and 41 completed weeks, elective induction of labour was associated with a decreased odds of perinatal mortality compared with expectant management (at 40 weeks' gestation 0.08% (37/44,764) in the induction of labour group versus 0.18% (627/350,643) in the expectant management group; adjusted odds ratio 0.39, 99% confidence interval 0.24 to 0.63), without a reduction in the odds of spontaneous vertex delivery (at 40 weeks' gestation 79.9% (35,775/44,778) in the induction of labour group versus 73.7% (258,665/350,791) in the expectant management group; adjusted odds ratio 1.26, 1.22 to 1.31). Admission to a neonatal unit was, however, increased in association with elective induction of labour at all gestations before 41 weeks (at 40 weeks' gestation 8.0% (3605/44,778) in the induction of labour group compared with 7.3% (25,572/350,791) in the expectant management group; adjusted odds ratio 1.14, 1.09 to 1.20).
Although residual confounding may remain, our findings indicate that elective induction of labour at term gestation can reduce perinatal mortality in developed countries without increasing the risk of operative delivery.
[show abstract][hide abstract] ABSTRACT: Background
Induction of labour (IOL) >41 weeks decreases perinatal mortality without increasing Caesarean rates.1 However, there is lack of data regarding outcomes of IOL prior to 41 weeks, particularly regarding effects on perinatal mortality.AimTo determine outcomes associated with IOL at term compared to expectant management.Methods
Interrogation of an unselected population database of 1.6 million births in Scotland (SMR02/SMR11/SBR/SSBID/GROS) between 1981 and 2007. Outcomes of women who underwent medically indicated or ‘elective’ (no recognised medical indication) IOL at 37-, 38-, 39-, 40- and 41-week gestation were compared to those of women who were managed expectantly (continued the pregnancy to either labour spontaneously or have IOL or Caesarean delivery at a later gestation). Women with contraindications to IOL were excluded. Multivariate analysis adjusted for age, year, parity and deprivation category.ResultsElective IOL was associated with decreased perinatal mortality when compared to expectant management (adjusted OR (AOR) 0.14 (0.04–0.43) at 37 weeks increasing to 0.32 (0.23–0.45) at 41 weeks). Odds of Caesarean were not increased at 37/38 weeks, and reduced at 40/41 weeks (AOR 1.06 (0.96–1.18) at 37 weeks decreasing to 0.67 (0.65–0.70) at 41 weeks). Odds of postpartum haemorrhage and anal sphincter injury were also decreased, although neonatal admissions to special care baby unit were increased. In contrast, medically indicated IOL was associated with increased odds of perinatal mortality and increased maternal complication rates.Conclusion
These data suggest that complications of IOL relate to the indication rather than the process of IOL itself. Elective IOL at term is associated with decreased perinatal mortality, without an increase in Caesarean delivery.
Archives of Disease in Childhood-fetal and Neonatal Edition - ARCH DIS CHILD-FETAL NEONATAL. 01/2010; 95(1).