title: Nonmedically indicated induction vs expectant treatment in term nulliparous women.
abstract: OBJECTIVE
  The purpose of this study was to compare maternal and neonatal outcomes in nulliparous women with nonmedically indicated inductions at term vs those expectantly treated.
  
  
  METHODS
  Data were obtained from maternal and neonatal charts for all deliveries on randomly selected days across 25 US hospitals over a 3-year period. A low-risk subset of nulliparous women with vertex nonanomalous singleton gestations who delivered 38 0/7 to 41 6/7 weeks were selected. Maternal and neonatal outcomes for nonmedically indicated induction within each week were compared with women who did not undergo nonmedically indicated induction during that week. Multivariable analysis was used to adjust for hospital, maternal age, race/ethnicity, body mass index, cigarette use, and insurance status.
  
  
  RESULTS
  We found 31,169 women who met our criteria. Neonatal complications were either less frequent with nonmedically indicated induction or no different between groups. Nonmedically indicated induction was associated with less frequent peripartum infections (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16-0.98) at 38 weeks of gestation and less frequent third- and fourth-degree lacerations (OR, 0.60; 95% CI, 0.42-0.86) and less frequent peripartum infections (OR, 0.66; 95% CI, 0.49-0.90) at 39 weeks of gestation. Nonmedically indicated induction was associated with a longer admission-to-delivery time by approximately 3-4 hours and increased odds of cesarean delivery at 38 (OR, 1.50; 95% CI, 1.08-2.08) and 40 weeks (OR, 1.30; 95% CI, 1.15-1.46) of gestation.
  
  
  CONCLUSIONS
  At 39 weeks of gestation, nonmedically indicated induction is associated with lower maternal and neonatal morbidity than women who are expectantly treated.
authors.affiliation: Departments of Obstetrics and Gynecology of: Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH. Electronic address: jbailit@metrohealth.org.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bailit
authors.affiliation: Prentice Women's Hospital, Northwestern University, Chicago, IL.
authors.forename: William
authors.initials: W
authors.lastname: Grobman
authors.affiliation: Biostatistics Center, George Washington University, Washington, DC.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
authors.forename: Uma M
authors.initials: UM
authors.lastname: Reddy
authors.affiliation: University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.affiliation: The Ohio State University Medical Center, Columbus, OH.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, AL.
authors.forename: Alan T
authors.initials: AT
authors.lastname: Tita
authors.affiliation: University of Texas Medical Branch, Galveston, TX.
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.affiliation: Wayne State University School of Medicine, Detroit, MI.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.affiliation: The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.affiliation: University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Blackwell
authors.affiliation: Oregon Health & Science University, Portland, OR.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: J Peter
authors.initials: JP
authors.lastname: VanDorsten
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007751:Labor, Induced; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D047929:Term Birth; D057832:Watchful Waiting; D055815:Young Adult
keywords: induction; nonmedically indicated induction; nulliparous women