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


CONCLUSIONS
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.
Le Ray
C
C
Université Pierre et Marie Curie Paris VI, INSERM Unit 149, Epidemiological Research Unit on Perinatal Health and Women's Health, Paris, France.
Carayol
M
M
Bréart
G
G
Goffinet
F
F
D000328:Adult; D002585:Cesarean Section; D005260:Female; D005602:France; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D016015:Logistic Models; D015999:Multivariate Analysis; D010121:Oxytocin / Q000008:administration & dosage; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
D010121:Oxytocin