Advertisement

Archives of Gynecology and Obstetrics

, Volume 284, Issue 2, pp 337–341 | Cite as

Is induced labour in the nullipara associated with more maternal and perinatal morbidity?

  • Dan Selo-OjemeEmail author
  • Cathy Rogers
  • Ashok Mohanty
  • Naseem Zaidi
  • Rose Villar
  • Panicos Shangaris
Materno-Fetal Medicine

Abstract

Purpose

To ascertain any differences in foetomaternal outcomes in induced and spontaneous labour among nulliparous women delivering at term.

Methods

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.

Results

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 2.95.5; 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.

Conclusion

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.

Keywords

Induction of labour Spontaneous labour Caesarean section Pregnancy complication Neonatal outcome 

Notes

Conflict of interest

There are no conflicts of interest to disclose.

References

  1. 1.
    Government Statistical Service for the Department of Health (2009) NHS maternity statistics, England: 2007–2008Google Scholar
  2. 2.
    National Institute for Clinical Excellence (2001) Clinical guideline D: induction of labor. National Institute for Clinical Excellence, LondonGoogle Scholar
  3. 3.
    Cammu H, Martens G, Ruyssinck G, Amy JJ (2002) Outcome after elective labor induction in nulliparous women: a matched cohort study. Am J Obstet Gynecol 186(2):240–244PubMedCrossRefGoogle Scholar
  4. 4.
    Seyb ST, Berka RJ, Socol ML, Dooley SL (1999) Risk of caesarean delivery with elective induction of labour at term in nulliparous women. Obstet Gynecol 94(4):600–607PubMedCrossRefGoogle Scholar
  5. 5.
    Luthy DA, Malmgren JA, Zingheim RW (2004) Caesarean delivery after elective induction in nulliparous women: the physician effect. Am J Obstet Gynecol 191(5):1511–1515PubMedCrossRefGoogle Scholar
  6. 6.
    Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ (2005) Bishop score and risk of caesarean delivery after induction of labour in nulliparous women. Obstet Gynecol 105(4):690–697PubMedCrossRefGoogle Scholar
  7. 7.
    Vahratian A, Zhang J, Troendle JF, Sciscione AC, Hoffman MK (2005) Labour progression and risk of caesarean delivery in electively induced nulliparas. Obstet Gynecol 105(4):698–704PubMedCrossRefGoogle Scholar
  8. 8.
    Yeast JD, Jones A, Poskin M (1999) Induction of labour and the relationship to caesarean delivery: a review of 7001 consecutive inductions. Am J Obstet Gynecol 180(3 Pt 1):628–633PubMedCrossRefGoogle Scholar
  9. 9.
    Prysak M, Castronova FC (1998) Elective induction versus spontaneous labour: a case control analysis of safety and efficacy. Obstet Gynecol 92(1):47–52PubMedCrossRefGoogle Scholar
  10. 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
  11. 11.
    Caughey AB, Sundaram V, Kaimal AJ, Gienger A, Cheng YW, McDonald KM, Shaffer BL, Owens DK, Bravata DM (2009) Systematic review: elective induction of labor versus expectant management of pregnancy. Ann Intern Med 151(4):252–263 W53–W63 (review)PubMedGoogle Scholar
  12. 12.
    Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM (2003) Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstet Gynecol 101(6):1312–1318PubMedCrossRefGoogle Scholar
  13. 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. 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
  15. 15.
    Glantz JC (2005) Elective induction vs. spontaneous labor associations and outcomes. J Reprod Med 50(4):235–240PubMedGoogle Scholar
  16. 16.
    Beebe L, Beaty C, Rayburn W (2007) Immediate neonatal outcomes after elective induction of labor. J Reprod Med 52(3):173–175PubMedGoogle Scholar
  17. 17.
    Maslow AS, Sweeny AL (2000) Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstet Gynecol 95(6 Pt 1):917–922PubMedCrossRefGoogle Scholar
  18. 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. 19.
    Lin MG, Rouse DJ (2006) Clinical obstetrics and gynaecology 49(3):585–593Google Scholar
  20. 20.
    Selo-Ojeme D, Pisal P, Lawal O, Rogers C, Shah A, Sinha S (2009) A randomised controlled trial of amniotomy and immediate oxytocin infusion versus amniotomy and delayed oxytocin infusion for induction of labor at term. Arch Gynaecol Obstet 276(6):813–820CrossRefGoogle Scholar
  21. 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
  22. 22.
    van Gemund N, Hardeman A, Scherjon SA, Kanhai HH (2003) Intervention rates after elective induction of labor compared to labor with a spontaneous onset. A matched cohort study. Gynecol Obstet Invest 56(3):133–138PubMedCrossRefGoogle Scholar
  23. 23.
    Svärdby K, Nordström L, Sellström E (2007) Primiparas with or without oxytocin augmentation: a prospective descriptive study. J Clin Nurs 16(1):179–184PubMedCrossRefGoogle Scholar
  24. 24.
    Macones GA (2009) Elective induction of labour: waking a sleeping dogma? Ann Intern Med 151:281–282PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Dan Selo-Ojeme
    • 1
    Email author
  • Cathy Rogers
    • 1
  • Ashok Mohanty
    • 1
  • Naseem Zaidi
    • 1
  • Rose Villar
    • 1
  • Panicos Shangaris
    • 1
  1. 1.Department of Obstetrics and Gynaecology, Women and Children’s Directorate, Barnet and Chase Farm Hospitals NHS TrustChase Farm HospitalEnfieldUK

Personalised recommendations