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Acta Obstet Gynecol Scand. 2007;86(6):657-65.

Elective induction of labor: failure to follow guidelines and risk of cesarean delivery.

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  • 1Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, Paris, France.

Abstract

BACKGROUND:

Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery.

METHODS:

We compared cesarean rates according to mode of onset of labor among 5,046 low-risk patients. Violation of the guidelines was defined as induction before 38 weeks or with a Bishop score <5 or with prostaglandins. The cesarean risk was analysed with a bivariable and then a multivariable analysis, which used a multilevel logistic model.

RESULTS:

Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR=4.1, 95% CI [1.3-12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR=3.2 [1.0-10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor.

CONCLUSION:

Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.

PMID:
17520395
[PubMed - indexed for MEDLINE]
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