title: Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes.
abstract: The objectives were to evaluate whether induction, specifically prolonged labor, was associated with adverse maternal outcomes related to preeclampsia with severe features (PEC-S) and whether cesarean affected the rate.
  
  
  
  This was a retrospective cohort study of women with PEC-S ⩾34 weeks who were diagnosed either before planned cesarean or before induction/latent labor. The primary outcome was a composite adverse maternal outcome related to PEC-S.
  
  
  
  The final cohort comprised 193 women (n=172 with labor and n=21 with planned cesarean). The prevalence of the outcome was 15.5%. Women exposed to labor did not have a higher rate compared with planned cesarean (16.3% vs 9.5%, P=0.4). Adjusting for confounders, women with a cesarean after prolonged labor had a 10-fold higher adverse outcome risk compared with women with a planned cesarean (adjusted odds ratio (aOR) 9.7 (1.2 to 78.6), P=0.03) or with a vaginal delivery <24 h (aOR 9.7 (1.4 to 67.4), P=0.02).
  
  
  
  Prolonged labor and cesarean in labor were both associated with an increase in our outcome.
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Levine
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Elovitz
authors.affiliation: Department of Obstetrics & Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Limaye
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Women's Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Srinivas
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; D016017:Odds Ratio; D010414:Pennsylvania; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult