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DOI: 10.1055/s-0043-1761918
Outcomes of Elective Induction of Labor at 39 Weeks from a Statewide Collaborative Quality Initiative
Funding Blue Cross/Blue Shield of Michigan and the Blue Care Network funded the Obstetrics Initiative and have provided salary support to all the authors. The funders were made aware of this publication; however, they did not participate in the writing or editing of the manuscript.
Abstract
Objective This article evaluates the impact of adopting a practice of elective induction of labor (eIOL) at 39 weeks among nulliparous, term, singleton, vertex (NTSV) pregnancies in a statewide collaborative.
Study Design We used data from a statewide maternity hospital collaborative quality initiative to analyze pregnancies that reached 39 weeks without a medical indication for delivery. We compared patients who underwent an eIOL versus those who experienced expectant management. The eIOL cohort was subsequently compared with a propensity score-matched cohort who were expectantly managed. The primary outcome was cesarean birth rate. Secondary outcomes included time to delivery and maternal and neonatal morbidities. Chi-square test, t-test, logistic regression, and propensity score matching methods were used for analysis.
Results In 2020, 27,313 NTSV pregnancies were entered into the collaborative's data registry. A total of 1,558 women underwent eIOL and 12,577 were expectantly managed. Women in the eIOL cohort were more likely to be ≥35 years old (12.1 vs. 5.3%, p < 0.001), identify as white non-Hispanic (73.9 vs. 66.8%, p < 0.001), and be privately insured (63.0 vs. 61.3%, p = 0.04). When compared with all expectantly managed women, eIOL was associated with a higher cesarean birth rate (30.1 vs. 23.6%, p < 0.001). When compared with a propensity score-matched cohort, eIOL was not associated with a difference in cesarean birth rate (30.1 vs. 30.7%, p = 0.697). Time from admission to delivery was longer for the eIOL cohort compared with the unmatched (24.7 ± 12.3 vs. 16.3 ± 11.3 hours, p < 0.001) and matched (24.7 ± 12.3 vs. 20.1 ± 12.0 hours, p < 0.001) cohorts. Expectantly managed women were less likely to have a postpartum hemorrhage (8.3 vs. 10.1%, p = 0.02) or operative delivery (9.3 vs. 11.4%, p = 0.029), whereas women who underwent an eIOL were less likely to have a hypertensive disorder of pregnancy (5.5 vs. 9.2%, p < 0.001).
Conclusion eIOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate.
Key Points
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Elective IOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate.
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The practice of elective induction of labor may not be equitably applied across birthing people.
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Further research is needed to identify best practices to support people undergoing labor induction.
Publikationsverlauf
Eingereicht: 03. März 2022
Angenommen: 16. Dezember 2022
Artikel online veröffentlicht:
16. Februar 2023
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References
- 1 Grobman WA, Rice MM, Reddy UM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
- 2 Berghella V, Al-Hafez L, Bellussi F. Induction for 39 weeks' gestation: let's call it what it is. Am J Obstet Gynecol MFM 2020; 2 (02) 100098
- 3 Carmichael SL, Snowden JM. The ARRIVE Trial: interpretation from an epidemiologic perspective. J Midwifery Womens Health 2019; 64 (05) 657-663
- 4 Society of Maternal-Fetal (SMFM) Publications Committee. Electronic address: pubs@smfm.org. SMFM statement on elective induction of labor in low-risk nulliparous women at term: the ARRIVE Trial. Am J Obstet Gynecol 2019; 221 (01) B2-B4
- 5 ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1): 386-397
- 6 Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70 (01) 41-55
- 7 Little RJ, Rubin DB. Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. Annu Rev Public Health 2000; 21: 121-145
- 8 Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46 (03) 399-424
- 9 Salahuddin M, Davidson C, Lakey DL, Patel DA. Characteristics associated with induction of labor and delivery route among primiparous women with term deliveries in the Listening to Mothers III Study. J Womens Health (Larchmt) 2018; 27 (05) 590-598
- 10 Declercq E, Belanoff C, Iverson R. Maternal perceptions of the experience of attempted labor induction and medically elective inductions: analysis of survey results from listening to mothers in California. BMC Pregnancy Childbirth 2020; 20 (01) 458
- 11 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2017. Natl Vital Stat Rep 2018; 67 (08) 1-50
- 12 American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
- 13 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep 2021; 70 (02) 1-51
- 14 Nikolian VC, Regenbogen SE. Statewide Clinic Registries: the Michigan Surgical Quality Collaborative. Clin Colon Rectal Surg 2019; 32 (01) 16-24