Archives of Gynecology and Obstetrics

, Volume 295, Issue 5, pp 1175–1183 | Cite as

Maternal and neonatal outcomes after induction of labor: a population-based study

  • Christoph Zenzmaier
  • Hermann Leitner
  • Christoph Brezinka
  • Willi Oberaigner
  • Martina König-Bachmann
Maternal-Fetal Medicine

Abstract

Purpose

To evaluate maternal and neonatal outcomes at and beyond term associated with induction of labor compared to spontaneous onset of labor stratified by week of gestational age.

Methods

In this retrospective cohort study, data form 402,960 singleton pregnancies from the Austria Perinatal Registry were used to estimate odds ratios of secondary cesarean delivery, operative vaginal delivery, epidural analgesia, fetal scalp blood testing, episiotomy, 3rd/4th-degree lacerations, retained placenta, 5-min APGAR <7, umbilical artery pH <7.1, and admission to neonatal intensive care unit. Multivariate logistic regression models based on deliveries with gestational age ≥37 + 0 were applied for adjustment for possible confounders.

Results

Induction of labor was associated with increased odds for cesarean delivery (adjusted OR; 99% confidence interval: 1.53; 1.45–1.60), operative vaginal delivery (1.21; 1.15–1.27), epidural analgesia (2.12; 2.03–2.22), fetal scalp blood testing (1.40; 1.28–1.52), retained placenta (1.32; 1.22–1.41), 5-min APGAR <7 (1.55; 1.27–1.89), umbilical artery pH <7.1 (1.26; 1.15–1.38), and admission to neonatal intensive care unit (1.41; 1.31–1.51). In a subgroup of induction of labor with the indication, “post-term pregnancy” induction was similarly associated with adverse outcomes.

Conclusions

In Austria, induction of labor is associated with increased odds of adverse maternal and neonatal outcomes. However, due to residual confounding, currently, no recommendations for treatment can be derived.

Keywords

Cesarean section Cohort study Epidural analgesia Induction of labor Maternal outcomes Neonatal outcomes 

References

  1. 1.
    Martin JA, Hamilton BE, Osterman MJ et al (2015) Births: final data for 2013. Natl Vital Stat Rep 64(1):1–65Google Scholar
  2. 2.
    EURO-PERISTAT Project with SCPE and EUROCAT (2013) European Perinatal Health Report. The health and care of pregnant women and babies in Europe in 2010Google Scholar
  3. 3.
    Osterman MJK, Martin JA (2014) Recent declines in induction of labor by gestational age. NCHS Data Brief (155):1–8Google Scholar
  4. 4.
    Oberaigner W, Leitner H (2015) Geburtenregister Österreich: Bericht Geburtsjahr 2014. IET, InnsbruckGoogle Scholar
  5. 5.
    Glantz JC (2005) Elective induction vs. spontaneous labor associations and outcomes. J Reprod Med 50(4):235–240PubMedGoogle Scholar
  6. 6.
    Bailit JL, Gregory KD, Reddy UM et al (2010) Maternal and neonatal outcomes by labor onset type and gestational age. Am J Obstet Gynecol 202(3):245.e1-245.e12. doi:10.1016/j.ajog.2010.01.051 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Grivell RM, Reilly AJ, Oakey H et al (2012) Maternal and neonatal outcomes following induction of labor: a cohort study. Acta Obstet Gynecol Scand 91(2):198–203. doi:10.1111/j.1600-0412.2011.01298.x CrossRefPubMedGoogle Scholar
  8. 8.
    Caughey AB, Sundaram V, Kaimal AJ et al. (2009) Systematic review: elective induction of labor versus expectant management of pregnancy. Ann Intern Med 151(4): 252–63, W53–63Google Scholar
  9. 9.
    Saccone G, Berghella V (2015) Induction of labor at full term in uncomplicated singleton gestations: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 213(5):629–636. doi:10.1016/j.ajog.2015.04.004 CrossRefPubMedGoogle Scholar
  10. 10.
    Gibson KS, Waters TP, Bailit JL (2014) Maternal and neonatal outcomes in electively induced low-risk term pregnancies. Am J Obstet Gynecol 211(3):249.e1-249.e16. doi:10.1016/j.ajog.2014.03.016 CrossRefPubMedGoogle Scholar
  11. 11.
    Darney BG, Snowden JM, Cheng YW et al (2013) Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol 122(4):761–769. doi:10.1097/AOG.0b013e3182a6a4d0 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Darney BG, Caughey AB (2014) Elective induction of labor symposium: nomenclature, research methodological issues, and outcomes. Clin Obstet Gynecol 57(2):343–362. doi:10.1097/GRF.0000000000000029 CrossRefPubMedGoogle Scholar
  13. 13.
    Vogel JP, Gülmezoglu, Ahmet M Metin, Hofmeyr GJ et al (2014) Global perspectives on elective induction of labor. Clin Obstet Gynecol 57(2):331–342. doi:10.1097/GRF.0000000000000031 CrossRefPubMedGoogle Scholar
  14. 14.
    Glantz JC (2014) Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol 123(2 Pt 1): 363. doi:10.1097/AOG.0000000000000114 PubMedGoogle Scholar
  15. 15.
    Snyder CC, Wolfe KB, Loftin RW et al (2011) The influence of hospital type on induction of labor and mode of delivery. Am J Obstet Gynecol 205(4):346.e1-4. doi:10.1016/j.ajog.2011.05.004 CrossRefPubMedGoogle Scholar
  16. 16.
    Moore J, Low LK (2012) Factors that influence the practice of elective induction of labor: what does the evidence tell us? J Perinat Neonatal Nurs 26(3):242–250. doi:10.1097/JPN.0b013e31826288a9 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Oppelt P, Plathow D, Oppelt A et al (2002) Feather - Datenerfassung in der Gynäkologie und Geburtshilfe (Feather–data acquisition in gynaecology and obstetrics). Zentralbl Gynakol 124(7):362–367. doi:10.1055/s-2002-35535 CrossRefPubMedGoogle Scholar
  18. 18.
    Weiss E, Abele H, Bartz C et al (2014) S1-Guideline: Management of Late-term and Post-term Pregnancy: Short version - AWMF Registry Number: 015/065. Geburtshilfe Frauenheilkd 74(12):1099–1103. doi:10.1055/s-0034-1383314 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bodner-Adler B, Bodner K, Pateisky N et al (2005) Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy: a comparison between elective labor induction and spontaneous onset of labor beyond term. Wien Klin Wochenschr 117(7–8):287–292CrossRefPubMedGoogle Scholar
  20. 20.
    Schwarz C, Schäfers R, Loytved C et al (2016) Temporal trends in fetal mortality at and beyond term and induction of labor in Germany 2005–2012: data from German routine perinatal monitoring. Arch Gynecol Obstet 293(2):335–343. doi:10.1007/s00404-015-3795-x CrossRefPubMedGoogle Scholar
  21. 21.
    Boulvain M, Marcoux S, Bureau M et al (2001) Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol 15(2):131–138CrossRefPubMedGoogle Scholar
  22. 22.
    Cammu H, Martens G, Ruyssinck G et al (2002) Outcome after elective labor induction in nulliparous women: a matched cohort study. Am J Obstet Gynecol 186(2):240–244CrossRefPubMedGoogle Scholar
  23. 23.
    van Gemund N, Hardeman A, Scherjon SA et al (2003) Intervention rates after elective induction of labor compared to labor with a spontaneous onset. A matched cohort study. Gynecol Obstet Invest 56(3):133–138CrossRefPubMedGoogle Scholar
  24. 24.
    Baud D, Rouiller S, Hohlfeld P et al (2013) Adverse obstetrical and neonatal outcomes in elective and medically indicated inductions of labor at term. J Matern Fetal Neonatal Med 26(16):1595–1601. doi:10.3109/14767058.2013.795533 CrossRefPubMedGoogle Scholar
  25. 25.
    Stock SJ, Ferguson E, Duffy A et al (2012) Outcomes of elective induction of labour compared with expectant management: population based study. BMJ 344:e2838. doi:10.1136/bmj.e2838 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Tracy SK, Sullivan E, Wang YA et al (2007) Birth outcomes associated with interventions in labour amongst low risk women: a population-based study. Women Birth 20(2):41–48. doi:10.1016/j.wombi.2007.03.005 CrossRefPubMedGoogle Scholar
  27. 27.
    Petersen A, Poetter U, Michelsen C et al (2013) The sequence of intrapartum interventions: a descriptive approach to the cascade of interventions. Arch Gynecol Obstet 288(2):245–254. doi:10.1007/s00404-013-2737-8 CrossRefPubMedGoogle Scholar
  28. 28.
    Selo-Ojeme D, Rogers C, Mohanty A et al (2011) Is induced labour in the nullipara associated with more maternal and perinatal morbidity? Arch Gynecol Obstet 284(2):337–341. doi:10.1007/s00404-010-1671-2 CrossRefPubMedGoogle Scholar
  29. 29.
    Schneider KTM, Butterwegge M, Daumer M et al (2014) S1-guideline on the use of CTG during pregnancy and labor: Long version - AWMF Registry No. 015/036. Geburtshilfe Frauenheilkd 74(8):721–732. doi:10.1055/s-0034-1382874
  30. 30.
    Ashwal E, Melamed N, Hiersch L et al (2014) The incidence and risk factors for retained placenta after vaginal delivery - a single center experience. J Matern Fetal Neonatal Med 27(18):1897–1900. doi:10.3109/14767058.2014.883374 CrossRefPubMedGoogle Scholar
  31. 31.
    Sheiner E, Sarid L, Levy A et al (2005) Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med 18(3):149–154. doi:10.1080/14767050500170088 CrossRefPubMedGoogle Scholar
  32. 32.
    Delnord M, Blondel B, Drewniak N et al (2014) Varying gestational age patterns in cesarean delivery: an international comparison. BMC Pregnancy Childbirth 14:321. doi:10.1186/1471-2393-14-321 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Heimstad R, Romundstad PR, Eik-Nes SH et al (2006) Outcomes of pregnancy beyond 37 weeks of gestation. Obstet Gynecol 108(3 Pt 1): 500–508. doi:10.1097/01.AOG.0000227783.65800.0f
  34. 34.
    Bailit JL, Grobman W, Zhao Y et al (2015) Nonmedically indicated induction vs expectant treatment in term nulliparous women. Am J Obstet Gynecol 212(1):103.e1-7. doi:10.1016/j.ajog.2014.06.054 CrossRefPubMedGoogle Scholar
  35. 35.
    Caughey AB, Nicholson JM, Cheng YW et al (2006) Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol 195(3):700–705. doi:10.1016/j.ajog.2006.07.003 CrossRefPubMedGoogle Scholar
  36. 36.
    Glantz JC (2010) Term labor induction compared with expectant management. Obstet Gynecol 115(1):70–76. doi:10.1097/AOG.0b013e3181c4ef96 CrossRefPubMedGoogle Scholar
  37. 37.
    Gülmezoglu AM, Crowther CA, Middleton P et al (2012) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev(6): CD004945. doi:10.1002/14651858.CD004945.pub3 PubMedCentralGoogle Scholar
  38. 38.
    Miller NR, Cypher RL, Foglia LM et al (2015) Elective induction of labor compared with expectant management of nulliparous women at 39 weeks of gestation: a randomized controlled trial. Obstet Gynecol 126(6):1258–1264. doi:10.1097/AOG.0000000000001154 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Christoph Zenzmaier
    • 1
  • Hermann Leitner
    • 2
  • Christoph Brezinka
    • 3
  • Willi Oberaigner
    • 2
  • Martina König-Bachmann
    • 1
  1. 1.University of Applied Sciences TyrolInnsbruckAustria
  2. 2.Institute of Clinical EpidemiologyTyrolean State Hospitals LtdInnsbruckAustria
  3. 3.Department of Gynecological Endocrinology and Reproductive MedicineMedical University of InnsbruckInnsbruckAustria

Personalised recommendations