Download PDF
Am J Perinatol 2018; 35(07): 660-668
DOI: 10.1055/s-0037-1608847
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term

T. Kawakita
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
U. M. Reddy
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
C. C. Huang
2   Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Hyattsville, Maryland
3   Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia
,
T. C. Auguste
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
4   MedStar Simulation Training & Education Lab, Washington, District of Columbia
,
D. Bauer
4   MedStar Simulation Training & Education Lab, Washington, District of Columbia
,
R. T. Overcash
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
› Author Affiliations Funding This project was funded in part with Federal funds (Grant # UL1TR000101 previously UL1RR031975) from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program (CTSA), a trademark of DHHS, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.”
Further Information

Publication History

04 October 2017

12 October 2017

Publication Date:
06 December 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objective We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term.

Study Design We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model.

Results Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749–0.770).

Conclusion We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

Keywords

induction of labor - nulliparous women - predictors - vaginal delivery - web calculator

Note

The data included in this paper were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the NICHD, NIH through contract number HHSN267200603425C. This study was presented as an oral presentation at the SMFM 37th Annual Meeting—The Pregnancy Meeting, Las Vegas, NV (January 23–28, 2017). MedStar Institutional Review Board approved the study (#2016–084, approved on May 19, 2016). The named authors alone are responsible for the views expressed in this manuscript, which does not necessarily represent the decisions or the stated policy of the NICHD.


Supplementary Material

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (01) 1-65
    PubMedSearch in Google Scholar
  • 2 Hoffman MK, Vahratian A, Sciscione AC, Troendle JF, Zhang J. Comparison of labor progression between induced and noninduced multiparous women. Obstet Gynecol 2006; 107 (05) 1029-1034
    CrossrefPubMedSearch in Google Scholar
  • 3 Osmundson S, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstet Gynecol 2011; 117 (03) 583-587
    CrossrefPubMedSearch in Google Scholar
  • 4 Gibson KS, Waters TP, Bailit JL. Maternal and neonatal outcomes in electively induced low-risk term pregnancies. Am J Obstet Gynecol 2014; 211 (03) 249.e1-249.e16
    PubMedSearch in Google Scholar
  • 5 Bailit JL, Grobman W, Zhao Y. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Nonmedically indicated induction vs expectant treatment in term nulliparous women. Am J Obstet Gynecol 2015; 212 (01) 103.e1-103.e7
    CrossrefPubMedSearch in Google Scholar
  • 6 Laughon SK, Zhang J, Troendle J, Sun L, Reddy UM. Using a simplified Bishop score to predict vaginal delivery. Obstet Gynecol 2011; 117 (04) 805-811
    CrossrefPubMedSearch in Google Scholar
  • 7 Ennen CS, Bofill JA, Magann EF, Bass JD, Chauhan SP, Morrison JC. Risk factors for cesarean delivery in preterm, term and post-term patients undergoing induction of labor with an unfavorable cervix. Gynecol Obstet Invest 2009; 67 (02) 113-117
    CrossrefPubMedSearch in Google Scholar
  • 8 Tolcher MC, Holbert MR, Weaver AL. , et al. Predicting cesarean delivery after induction of labor among nulliparous women at term. Obstet Gynecol 2015; 126 (05) 1059-1068
    CrossrefPubMedSearch in Google Scholar
  • 9 Pevzner L, Rayburn WF, Rumney P, Wing DA. Factors predicting successful labor induction with dinoprostone and misoprostol vaginal inserts. Obstet Gynecol 2009; 114 (2 Pt 1): 261-267
    CrossrefPubMedSearch in Google Scholar
  • 10 Kim LH, Cheng YW, Delaney S, Jelin AC, Caughey AB. Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?. J Matern Fetal Neonatal Med 2010; 23 (05) 383-388
    CrossrefPubMedSearch in Google Scholar
  • 11 Walker KF, Bugg GJ, Macpherson M. , et al; 35/39 Trial Group. Randomized trial of labor induction in women 35 years of age or older. N Engl J Med 2016; 374 (09) 813-822
    CrossrefPubMedSearch in Google Scholar
  • 12 Zhang J, Troendle J, Reddy UM. , et al; Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203 (04) 326.e1-326.e10
    CrossrefPubMedSearch in Google Scholar
  • 13 Brennan DJ, Murphy M, Robson MS, O'Herlihy C. The singleton, cephalic, nulliparous woman after 36 weeks of gestation: contribution to overall cesarean delivery rates. Obstet Gynecol 2011; 117 (2 Pt 1): 273-279
    CrossrefPubMedSearch in Google Scholar
  • 14 Zhang J, Landy HJ, Branch DW. , et al; Consortium on Safe Labor. Contemporary patterns of spontaneous labor with normal neonatal outcomes. Obstet Gynecol 2010; 116 (06) 1281-1287
    CrossrefPubMedSearch in Google Scholar
  • 15 Osterman MJ, Martin JA. Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006-2012. Natl Vital Stat Rep 2014; 63 (01) 1-11
    PubMedSearch in Google Scholar
  • 16 Caughey AB, Cahill AG, Guise JM, Rouse DJ. ; American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193
    CrossrefPubMedSearch in Google Scholar