title: The indication for induction of labor impacts the risk of cesarean delivery.
abstract: OBJECTIVE
  The risk of cesarean delivery following labor induction has been clearly established. While numerous factors are known to impact this risk, the indication for induction has rarely been examined as a risk factor. This study aimed to examine the relationship between indication for induction and ultimate mode of delivery after labor induction.
  
  
  METHODS
  A retrospective cohort study was conducted examining all cases of labor induction in a tertiary center university teaching hospital over a one-year period. The primary outcome measure was mode of delivery (vaginal delivery versus cesarean delivery) and its relationship to the indication for induction. Secondary outcome measures were: parity, maternal age, birth week, cervical maturity, use of epidural anesthesia, fetal birth weight and fetal sex.
  
  
  RESULTS
  Seven hundred and ninety-six women met inclusion criteria, of which 17.1% ultimately underwent cesarean delivery. Using multivariate analysis, fetal indications for induction (including intra-uterine growth restriction, oligohydramnios, placental abruption, macrosomia and post-term pregnancy) were found to significantly increase the risk of cesarean delivery in nulliparous women. The other significant factor was birth after week 40 + 0.
  
  
  CONCLUSIONS
  The indication for labor induction impacts the risk of cesarean delivery. Specifically, induction of labor for fetal indications significantly increases the risk of cesarean delivery in nulliparous women.
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Parkes
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Kabiri
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Hants
authors.affiliation: a Department of Obstetrics and Gynecology , Hadassah-Hebrew University Medical Center , Jerusalem , Israel.
authors.forename: Yossef
authors.initials: Y
authors.lastname: Ezra
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Cesarean delivery; indication for induction; induction of labor