Citation Information :
Begum J. Outcomes of Elective Induction of Labor Compared with Expectant Management in Nulliparous Women with Unfavorable Cervix. J South Asian Feder Obs Gynae 2018; 10 (1):23-28.
Objectives: The purpose of this study was to test the association between elective induction of labor and cesarean delivery and to determine maternal and neonatal outcomes in elective induction of labor.
Materials and methods: We conducted a retrospective matched cohort study in a tertiary care hospital from January 2014 to December 2015, among 182 nulliparous women at gestational age of 390/7 weeks or more who had single live pregnancy with known cervical status of ≥5 at 380/7 to 386/7 weeks and were managed either by elective induction or expectant management. Data were compared using χ2 and Student's t-test, and p < 0.05 was considered significant.
Results: The cesarean delivery rate was 51% in expectant and 46.8% in elective induction group, which was not much different. Women who were electively induced spent more time in labor delivery unit (14 hours, 21 minutes vs 12 hours, 45 minutes, p < 0.01), had labor longer than 12 hours (50 vs 36.5%, p = 0.05), received more frequently oxytocin (63.5 vs 47.9%, p = 0.03), and were more likely to deliver during daytime between 6.00 am and 6.00 pm (64.5 vs 52%, p = 0.07) compared with expectant group. There were no difference with regard to obstetric events and maternal neonatal outcomes.
Conclusion: Elective induction did not result in increased risk of cesarean delivery in nulliparous women with unfavorable cervix. It is relatively safe as we had observed no evidence of any other increased adverse maternal or neonatal outcomes with elective induction.
ACOG Committee on Practice Bulletins—Obstetrics. American College of Obstetricians and Gynecologists Practice Bulletin No. 107: induction of labor. Obstet Gynecol 2009 Aug;114 (2 Pt 1):386-397.
Wing DA. Elective induction of labor in the USA. Curr Opin Obstet Gynecol 2000 Dec;12(6):457-462.
Johnson DP, Davis NR, Brown AJ. Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix. Am J Obstet Gynecol 2003 Jun;188(6): 1565-1572.
Vahratian A, Zhang J, Troendle JF, Sciscione AC, Hoffman MK. Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol 2005 Apr;105(4):698-704.
Vrouenraets FPJM, Roumen FJME, Dehing CJG, van den Akker ES, Aarts MJ, Scheve EJ. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 2005 Apr;105(4):690-697.
Dublin S, Lydon-Rochelle M, Kaplan RC, Watts DH, Critchlow CW. Maternal and neonatal outcomes after induction of labor without an identified indication. Am J Obstet Gynecol 2000 Oct;183(4):986-994.
Seyb ST, Berka RJ, Socol ML, Dooley SL. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol 1999 Oct;94(4):600-607.
Mahomed K, Pungsornruk K, Gibbons K. Induction of labour for postdates in nulliparous women with uncomplicated pregnancy—is the caesarean section rate really lower? J Obstet Gynaecol 2016 Oct;36(7):916-920. DOI: 10.1080/01443615.2016.1174824.
Thorsell M, Lyrenda S, Andolf E, Kaijser M. Induction of labor and the risk for emergency cesarean section in nulliparous and multiparous women. Acta Obstet Gynecol Scand 2011 Oct;90(10):1094-1099.
Pavicic H, Hamelin K, Menticoglou SM. Does routine induction of labour at 41 weeks really reduce the rate of caesarean section compared with expectant management? J Obstet Gynecol 2009 Jul;31(7):621-626.
Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL, Wang EE, Weston JA, Willan AR. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N Engl J Med 1996 Apr;334(16):1005-1010.
Dyson DC, Miller PD, Armstrong MA. Management of prolonged pregnancy: induction of labor versus antepartum fetal testing. Am J Obstet Gynecol 1987 Apr;156(4):928-934. [PMID:3472 467].
Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington AE. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol 2006 Sep;195(3): 700-705.
Osmundson S, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstet Gynecol 2011 Mar;117(3):583-587.
Cheng YW, Kaimal AJ, Snowden JM, Nicholson JM, Caughey AB. Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes. Am J Obstet Gynecol. 2012 Dec;207(6) 502.e501–502.e508.
Darney BG, Snowden JM, Cheng YW, Jacob L, Nicholson JM, Kaimal A, Dublin S, Getahun D, Caughey AB. Elective induction of labor at term compared to expectant management: maternal and neonatal outcomes. Obstet Gynecol 2013 Oct;122(4):761-769.
Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. Can Med Assoc J 2014 Jun;186(9):665-673.
Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? a systematic review and metaanalysis of trials in women with intact membranes. Br J Obstet Gynaecol 2014 May;121(6):674-685.
Macer JA, Macer CL, Chan LS. Elective induction versus spontaneous labor: a retrospective study of complications and outcome. Am J Obstet Gynecol 1992 Jun;166(6 Pt 1):1690-1697.
Prysak M, Castronova FC. Elective induction versus spontaneous labor a case control analysis of safety and efficacy. Obstet Gynecol 1998 Jul;92(1):47-52.
Gulmezoglu AM, Crowther CA, Middleton P, et al. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2012 Jun;6:CD004945.