title: Maternal and neonatal outcomes by labor onset type and gestational age.
abstract: OBJECTIVE
  We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.
  
  
  METHODS
  We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.
  
  
  RESULTS
  Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.
  
  
  CONCLUSIONS
  Some neonatal outcomes improved until 39 weeks. Babies born with elective induction are associated with better neonatal outcomes compared to spontaneous labor. Elective induction may be associated with an increased hysterectomy risk.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.forename: Victor H
authors.initials: VH
authors.lastname: Gonzalez-Quintero
authors.forename: Judith U
authors.initials: JU
authors.lastname: Hibbard
authors.forename: Mildred M
authors.initials: MM
authors.lastname: Ramirez
authors.forename: D Ware
authors.initials: DW
authors.lastname: Branch
authors.forename: Ronald
authors.initials: R
authors.lastname: Burkman
authors.forename: Shoshana
authors.initials: S
authors.lastname: Haberman
authors.forename: Christos G
authors.initials: CG
authors.lastname: Hatjis
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Hoffman
authors.forename: Michelle
authors.initials: M
authors.lastname: Kominiarek
authors.forename: Helain J
authors.initials: HJ
authors.lastname: Landy
authors.forename: Lee A
authors.initials: LA
authors.lastname: Learman
authors.forename: James
authors.initials: J
authors.lastname: Troendle
authors.forename: Paul
authors.initials: P
authors.lastname: Van Veldhuisen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Wilkins
authors.forename: Liping
authors.initials: L
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000453:epidemiology; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000453:epidemiology; D004716:Endometritis / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007362:Intensive Care Units; D007363:Intensive Care Units, Neonatal; D007751:Labor, Induced; D007743:Labor, Obstetric; D007902:Length of Stay / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology