Maternal and Neonatal Outcomes of Induction of Labor Compared with Planned Cesarean Delivery in Women with Preeclampsia at 34 Weeks' Gestation or Longer

Abstract

Objective This study aims to compare outcomes of induction with planned cesarean in women with preeclampsia.

Study Design A retrospective cohort study, including women with singleton pregnancies, preeclampsia (mild, severe, and superimposed), and without previous cesarean at ≥ 34 weeks' gestation was conducted. Outcomes included primary outcome (intensive care unit [ICU] admission, thromboembolism, transfusion, and hysterectomy), composite severe neonatal outcome (asphyxia, arterial cord pH < 7.0, hypoxic–ischemic encephalopathy, and 5-minute Apgar score < 5), neonatal ICU (NICU) admission, transient tachypnea of newborn (TTN), and respiratory distress syndrome (RDS). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, controlling for confounders.

Results Of 5,506 women with preeclampsia at ≥ 34 weeks' gestation, 5,104 (92.7%) women underwent induction. Induction compared with planned cesarean was not associated with an increased risk of the primary outcome but was related to increased risks of ICU admission (aOR: 3.29; 95% CI: 1.02–10.64), and linked to decreased risks of composite neonatal outcome (aOR: 0.32; 95% CI: 0.10–0.99), NICU admission (aOR: 0.60; 95% CI: 0.43–0.84), TTN (aOR: 0.38; 95% CI: 0.22–0.64), and RDS (aOR: 0.44; 95% CI: 0.22–0.86).

Conclusion Induction was not associated with an increased risk of the primary outcome but was associated with an increased risk of ICU admission and decreased risks of neonatal outcomes.

Keywords

cesarean delivery - induction of labor - intensive care unit - preeclampsia

Funding

The data included in this article were obtained from the Consortium on Safe Labor, supported by the Intramural Research Program of the NICHD, National Institutes of Health (NIH) through contract number HHSN267200603425C.

This project was funded in part with Federal funds (grant no. UL1TR000101 previously UL1RR031975) from the National Center for Advancing Translational Sciences (NCATS), NIH, through the Clinical and Translational Science Awards Program (CTSA), a trademark of Department of Health and Human Services, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.”

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