Is induced labour in the nullipara associated with more maternal and perinatal morbidity?
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To ascertain any differences in foetomaternal outcomes in induced and spontaneous labour among nulliparous women delivering at term.
A retrospective matched cohort study consisting of 403 nulliparous women induced at ≥292 days and 806 nulliparous women with spontaneous labour at 285–291 days.
Compared to those in spontaneous labour, women who had induction of labour were three times more likely to have a caesarean delivery (OR 3.1, 95% CI 2.4–4.1; P < 0.001). Women who had induction of labour were 2.2 times more likely to have oxytocin augmentation (OR 2.2, 95% CI 1.7–2.8; P < 0.001), 3.6 times more likely to have epidural anaesthesia (OR 3.6, 95% CI 2.8–4.6; P < 0.001), 1.7 times more likely to have uterine hyperstimulation (OR 1.7, 95% CI 1.1–2.6), 2 times more likely to have a suspicious foetal heart rate trace (OR 2.0, 95% CI 1.5–2.6), 4.1 times more likely to have blood loss over 500 ml (OR 4.1, 95% CI 2.9–5.5; P < 0.001), and 2.9 times more likely to stay in hospital beyond 5 days (OR 2.9, 95% CI 1.5–5.6; P < 0.001). Babies born to mothers who had induction of labour were significantly more likely to have an Apgar score of <5 at 5 min and an arterial cord pH of <7.0.
Compared to those with spontaneous labour, nulliparous women with induced labours are more likely to have uterine hyperstimulation, caesarean delivery, and babies with low Apgar scores. Nulliparous women should be made aware of this, as well as potential risks of expectant management during counseling.
KeywordsInduction of labour Spontaneous labour Caesarean section Pregnancy complication Neonatal outcome
Conflict of interest
There are no conflicts of interest to disclose.
- 1.Government Statistical Service for the Department of Health (2009) NHS maternity statistics, England: 2007–2008Google Scholar
- 2.National Institute for Clinical Excellence (2001) Clinical guideline D: induction of labor. National Institute for Clinical Excellence, LondonGoogle Scholar
- 10.Gülmezoglu AM (2006) Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 18(4):CD004945Google Scholar
- 13.Hannah ME, Hannah WJ, Hellmann J, Hewson S, Milner R, Willan A (1992) Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group. N Engl J Med 326(24):1587–1592 (Erratum in: N Engl J Med 30;327)PubMedCrossRefGoogle Scholar
- 14.Bodner-Adler B, Bodner K, Pateisky N, Kimberger O, Chalubinski K, Mayerhofer K, Husslein P (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):287–292PubMedCrossRefGoogle Scholar
- 18.National Institute for Health and Clinical Excellence (2008) Clinical guideline D: induction of labor. National Institute for Health and Clinical Excellence, LondonGoogle Scholar
- 19.Lin MG, Rouse DJ (2006) Clinical obstetrics and gynaecology 49(3):585–593Google Scholar
- 21.Egarter CH, Husslein PW, Rayburn WF (1990) Uterine hyperstimulation after low dose prostaglandin E2 therapy: tocolytic treatment in 181 cases. Am J Obstet Gynecol 63(3):794–796Google Scholar