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Am J Obstet Gynecol. 2015 Jan;212(1):103.e1-7. doi: 10.1016/j.ajog.2014.06.054. Epub 2014 Jun 28.

Nonmedically indicated induction vs expectant treatment in term nulliparous women.

Author information

1
Departments of Obstetrics and Gynecology of: Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH. Electronic address: jbailit@metrohealth.org.
2
Prentice Women's Hospital, Northwestern University, Chicago, IL.
3
Biostatistics Center, George Washington University, Washington, DC.
4
College of Physicians and Surgeons, Columbia University, New York, NY.
5
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
6
University of Utah Health Sciences Center, Salt Lake City, UT.
7
University of Texas Southwestern Medical Center, Dallas, TX.
8
University of Pittsburgh School of Medicine, Pittsburgh, PA.
9
The Ohio State University Medical Center, Columbus, OH.
10
University of Alabama at Birmingham School of Medicine, Birmingham, AL.
11
University of Texas Medical Branch, Galveston, TX.
12
Wayne State University School of Medicine, Detroit, MI.
13
The Warren Alpert Medical School of Brown University, Providence, RI.
14
University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
15
Oregon Health & Science University, Portland, OR.
16
Medical University of South Carolina, Charleston, SC.

Abstract

OBJECTIVE:

The purpose of this study was to compare maternal and neonatal outcomes in nulliparous women with nonmedically indicated inductions at term vs those expectantly treated.

STUDY DESIGN:

Data were obtained from maternal and neonatal charts for all deliveries on randomly selected days across 25 US hospitals over a 3-year period. A low-risk subset of nulliparous women with vertex nonanomalous singleton gestations who delivered 38 0/7 to 41 6/7 weeks were selected. Maternal and neonatal outcomes for nonmedically indicated induction within each week were compared with women who did not undergo nonmedically indicated induction during that week. Multivariable analysis was used to adjust for hospital, maternal age, race/ethnicity, body mass index, cigarette use, and insurance status.

RESULTS:

We found 31,169 women who met our criteria. Neonatal complications were either less frequent with nonmedically indicated induction or no different between groups. Nonmedically indicated induction was associated with less frequent peripartum infections (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16-0.98) at 38 weeks of gestation and less frequent third- and fourth-degree lacerations (OR, 0.60; 95% CI, 0.42-0.86) and less frequent peripartum infections (OR, 0.66; 95% CI, 0.49-0.90) at 39 weeks of gestation. Nonmedically indicated induction was associated with a longer admission-to-delivery time by approximately 3-4 hours and increased odds of cesarean delivery at 38 (OR, 1.50; 95% CI, 1.08-2.08) and 40 weeks (OR, 1.30; 95% CI, 1.15-1.46) of gestation.

CONCLUSION:

At 39 weeks of gestation, nonmedically indicated induction is associated with lower maternal and neonatal morbidity than women who are expectantly treated.

KEYWORDS:

induction; nonmedically indicated induction; nulliparous women

PMID:
24983681
PMCID:
PMC4275393
DOI:
10.1016/j.ajog.2014.06.054
[Indexed for MEDLINE]
Free PMC Article

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