Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?
OBJECTIVE
To determine whether preeclampsia is associated with an increased risk of cesarean delivery if labor is induced.


METHODS
This retrospective cohort study of 3505 women >or=24 weeks gestation with singleton pregnancies undergoing labor induction compares cesarean delivery rates between preeclamptics and non-preeclamptics. Multivariable logistic regression analysis was used to control for potential confounders including unfavorable cervix (Bishop score <or=5), method of labor induction, maternal age, parity, gestational age, race/ethnicity, epidural use, medical insurance, and marital status.


RESULTS
Among term nulliparous women undergoing labor induction, preeclamptics had a higher cesarean delivery rate then non-preeclamptics (81/267, 30% vs. 363/1568, 23%; p = 0.011), as did preeclamptic compared with non-preeclamptic women who were term and multiparous (10/64, 16% vs. 55/900, 6%, p = 0.003). Preterm preeclamptics also had more cesarean deliveries compared with non-preeclamptics among nulliparous (48/164, 29% vs. 16/245, 7%; p < 0.001) and multiparous (13/72, 18% vs. 18/225, 8%; p = 0.015) women. In multivariable analysis, preeclampsia still conferred an increased risk of cesarean delivery if labor was induced (adjusted odd ratio = 1.90, 95% CI 1.45-2.48).


CONCLUSIONS
Women with preeclampsia undergoing labor induction had higher cesarean delivery rates compared with non-preeclamptics regardless of parity or gestational age. However, the majority of women with preeclampsia still had successful vaginal deliveries.
Kim
Lena Heesun
LH
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California 94143-0132, USA. kimlh@obgyn.ucsf.edu
Cheng
Yvonne W
YW
Delaney
Shani
S
Jelin
Angie Child
AC
Caughey
Aaron B
AB
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000009:adverse effects* / Q000706:statistics & numerical data*; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult