Preventive induction of labor for non-urgent indications at term and maternal and neonatal outcomes.
BACKGROUND
Induction of labor (IOL) is a common practice in many parts of the world. However, the benefits and risks of preventive IOL for the mother and baby have yet to be critically assessed. This study is to investigate the effects of preventive IOL for non-urgent indications at term on maternal and neonatal outcomes.


METHODS
In this study, we applied a propensity score model to mimic a randomized clinical trial. Maternal and neonatal outcomes were compared between women with preventive IOL at 37-39 weeks of gestation and women with ongoing pregnancy (expectant management). The subjects were from the Consortium on Safe Labor, a study of over 200,000 births from 19 hospitals across the US from 2002 to 2008.


RESULTS
Both nulliparous and multiparous women induced preventively for non-urgent indications at 37-38 weeks' gestation had lower rates of cesarean delivery compared to those delivered at later gestational weeks. However, preventive IOL was associated with increased risks of adverse neonatal outcomes (adjusted odds ratio [aOR] = 1.68, 95% confidence interval [CI], 0.97-2.92 for nulliparas; aOR = 2.22, 1.32-3.74 for multiparas) and admission to NICU (aOR = 1.48, 0.99-2.20 for nulliparas; aOR = 2.08, 1.47-2.96 for multiparas) at 37 weeks' gestation. A longer maternal hospital stay was found among all women with preventive IOL.


CONCLUSIONS
Preventive IOL for non-urgent indications may be associated with a decreased risk of cesarean delivery at early term but increased risks of adverse neonatal outcomes at 37 weeks. It also results in a longer hospital stay than expectant management.
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Lin
L
Zhang
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Hao
H
Zhang
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China. junjimzhang@gmail.com.
Jun
J
Zhang
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Jin Wen
JW
Zhang
Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Jiang Feng
JF
Ye
Intermountain HealthCare and University of Utah, Salt Lake City, UT, USA.
D Ware
DW
Branch
D000328:Adult; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007751:Labor, Induced / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D057216:Propensity Score; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D047929:Term Birth; D014481:United States / Q000453:epidemiology
Cesarean delivery; Maternal outcomes; Neonatal outcomes; Preventive induction of labor; Propensity score model