title: Elective induction versus spontaneous labour in Latin America.
abstract: OBJECTIVE
  To assess the frequency of elective induction of labour and its determinants in selected Latin America countries; quantify success in attaining vaginal delivery, and compare rates of caesarean and adverse maternal and perinatal outcomes after elective induction versus spontaneous labour in low-risk pregnancies.
  
  
  METHODS
  Of 37,444 deliveries in women with low-risk pregnancies, 1847 (4.9%) were electively induced. The factors associated with adverse maternal and perinatal outcomes among cases of spontaneous and induced onset of labour were compared. Odds ratios for factors potentially associated with adverse outcomes were calculated, as were the relative risks of having an adverse maternal or perinatal outcome (both with their 95% confidence intervals). Adjustment using multiple logistic regression models followed these analyses.
  
  
  RESULTS
  Of 11,077 cases of induced labour, 1847 (16.7%) were elective. Elective inductions occurred in 4.9% of women with low-risk pregnancies (37,444). Oxytocin was the most common method used (83% of cases), either alone or combined with another. Of induced deliveries, 88.2% were vaginal. The most common maternal adverse events were: (i) a higher postpartum need for uterotonic drugs, (ii) a nearly threefold risk of admission to the intensive care unit; (iii) a fivefold risk of postpartum hysterectomy, and (iv) an increased need for anaesthesia/analgesia. Perinatal outcomes were satisfactory except for a 22% higher risk of delayed breastfeeding (i.e. initiation between 1 hour and 7 days postpartum).
  
  
  CONCLUSIONS
  Caution is mandatory when indicating elective labour induction because the increased risk of maternal and perinatal adverse outcomes is not outweighed by clear benefits.
authors: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, SP, Brazil.
authors: Gláucia Virgínia
authors: GV
authors: Guerra
authors: José Guilherme
authors: JG
authors: Cecatti
authors: João Paulo
authors: JP
authors: Souza
authors: Aníbal
authors: A
authors: Faúndes
authors: Sirlei Siani
authors: SS
authors: Morais
authors: Ahmet Metin
authors: AM
authors: Gülmezoglu
authors: Renato
authors: R
authors: Passini
authors: Mary Angela
authors: MA
authors: Parpinelli
authors: Guillermo
authors: G
authors: Carroli
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D007743:Labor, Obstetric / Q000187:drug effects*; D007843:Latin America / Q000453:epidemiology; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D055815:Young Adult