Indications and results of labour induction in nulliparous women: an interview among obstetricians, residents and clinical midwives.
OBJECTIVE
To investigate which clinical factors are important in management decisions that clinicians make in the process of labour induction, and which clinical factors they estimate as predictive of labour outcome after induction.


METHODS
A written interview was conducted among obstetricians, residents and clinical midwives in five teaching hospitals in the south of the Netherlands. Sixteen fictive vignettes were constructed of pregnant nulliparous women who were candidates for induction of labour. The vignettes differed on eight clinical variables: maternal age, BMI, gestational age, indication for induction (maternal request vs mild pre-eclampsia), dilation, position, consistency and effacement of the cervix. For each case presentation, the inclination to induce labour was calculated for the three groups, and their estimates of the probability of a spontaneous vaginal delivery or a caesarean delivery were analyzed.


RESULTS
Of the 80 questionnaires sent, 60 (75%) were completed. Mild pre-eclampsia and post-term pregnancy were the most important clinical factors for the decision to induce or not in all three groups. Gestational age, effacement and dilation of the cervix were considered as the most important predictors of labour outcome after induction.


CONCLUSIONS
In this interview, obstetricians, residents and clinical midwives based their decision-making whether or not to induce labour predominantly on medical indications. Outcome of labour after induction was estimated to depend on gestational age and cervical status at the start of induction.
Vellekoop
Jorik
J
Department of Obstetrics & Gynaecology, Atrium Medical Centre Parkstad, 6401 CX Heerlen, The Netherlands. jorikvellekoop@hetnet.nl
Vrouenraets
Francis P J M
FP
van der Steeg
Jan Willem
JW
Mol
Ben W J
BW
Roumen
Frans J M E
FJ
D000328:Adult; D003657:Decision Making; D005260:Female; D005865:Gestational Age; D006801:Humans; D007407:Interviews as Topic; D007747:Labor Stage, First; D007751:Labor, Induced; D008423:Maternal Age; D008880:Midwifery; D009774:Obstetrics; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged / Q000453:epidemiology; D012307:Risk Factors; D013038:Specialization