Skip to main content

Advertisement

SpringerLink
Log in

Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes

  • Original Article
  • Published:
Journal of Perinatology Submit manuscript

Abstract

Objective:

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.

Study Design:

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.

Results:

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).

Conclusion:

Prolonged labor and cesarean in labor were both associated with an increase in our outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; 183: S1–S22.

  2. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy: report from the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5): 1122–1131.

    Article  Google Scholar 

  3. Sibai B, Kupferminc M . Preeclampsia. Lancet 2005; 365: 785–799.

    Article  Google Scholar 

  4. Sibai BM . Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2001; 102: 181–192.

    Google Scholar 

  5. Sibai BM, Barton JR . Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol 2007; 196 (6): 514.e1–e9.

    Article  Google Scholar 

  6. Odendaal HJ, Pattinson RC, Bam R, Grove D, Kotze TJ . Aggressive or expectant management for patients with severe preeclampsia between 28-34 weeks’ gestation: a randomized controlled trial. Obstet Gynecol 1990; 76: 1070–1075.

    CAS  PubMed  Google Scholar 

  7. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA . Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169: 1000–1006.

    Article  CAS  Google Scholar 

  8. Douglas KA, Redman CW . Eclampsia in the United Kingdom. BMJ 1994; 309 (6966): 1395–1400.

    Article  CAS  Google Scholar 

  9. Amorim MMR, Souza ASR, Noronha Neto C. Planned cesarean section versus planned vaginal delivery for severe preeclampsia (protocol). Cochrane Database Syst Rev 2011 (11): CD009430.

  10. Roberts JM, Funai EF. Chapter 35: Pregnancy-related hypertension. Creasy & Resnik’s Maternal Fetal Medicine: Principles and Practice. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TJ (eds). 6th edn, Saunders: Philadelphia, PA, p 668.

  11. Amorim MM, Katz L, Barros AS, Almeida TS, Souza AS, Faundes A . Maternal outcomes according to mode of delivery in women with severe preeclampsia: a cohort study. J Matern Fetal Neonatal Med 2015; 28 (6): 654–660.

    Article  Google Scholar 

  12. Maghoma J, Buchmann J . Maternal and fetal risks associated with prolonged latent phase of labour. J Obstet Gynecol 2002; 22 (1): 16–19.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was funded in part by a career development award in Women’s Reproductive Health Research: K12-HD001265-14.

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, Maternal and Child Health Research Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    L D Levine, M A Elovitz & S K Srinivas

  2. Department of Obstetrics & Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, USA,

    M Limaye

  3. 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

    M D Sammel

Authors
  1. L D Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M A Elovitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Limaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M D Sammel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S K Srinivas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L D Levine.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

This study was presented as a poster at the Annual Meeting for the Society of Maternal Fetal Medicine in San Diego, CA, on 6 February 2015.

Supplementary Information accompanies the paper on the Journal of Perinatology website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levine, L., Elovitz, M., Limaye, M. et al. Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes. J Perinatol 36, 713–717 (2016). https://doi.org/10.1038/jp.2016.84

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2016.84

  • Springer Nature America, Inc.

This article is cited by

Search

Navigation