Format

Send to

Choose Destination
BMC Pregnancy Childbirth. 2019 Nov 29;19(1):455. doi: 10.1186/s12884-019-2615-x.

The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study.

Author information

1
Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, C210 Foothills Medical Centre, 1403 29th Street, NW, Calgary, Alberta, T2N 2T9, Canada. laskeith@ucalgary.ca.
2
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. laskeith@ucalgary.ca.
3
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
4
Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
5
Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, the Netherlands.
6
Academic Medical Center, Department of Vascular Medicine, Amsterdam, the Netherlands.
7
Academic Medical Center, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Amsterdam, the Netherlands.
8
Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland.
9
Department of Hematology, Nimes University Hospital and University of Montpellier, Montpellier, France.
10
A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
11
Department of Obstetrics and Gynecology, Jena University Hospital Friedrich Schiller University, Jena, Germany.
12
Clinical Trial Centre, University of Leipzig, Leipzig, Germany.
13
Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.

Abstract

BACKGROUND:

To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction).

METHODS:

The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor.

RESULTS:

There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p = 0.01).

CONCLUSIONS:

The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.

KEYWORDS:

Cesarean section; Induced labor; Low-molecular-weight heparin; Pre-eclampsia

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center