Nonmedically indicated induction vs expectant treatment in term nulliparous women

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

OBJECTIVE: The purpose of this study was to compare maternal and neonatal outcomes in nulliparous women with nonmedically indicated inductions at term vs those expectantly treated.

STUDY DESIGN: Data were obtained from maternal and neonatal charts for all deliveries on randomly selected days across 25 US hospitals over a 3-year period. A low-risk subset of nulliparous women with vertex nonanomalous singleton gestations who delivered 38 0/7 to 41 6/7 weeks were selected. Maternal and neonatal outcomes for nonmedically indicated induction within each week were compared with women who did not undergo nonmedically indicated induction during that week. Multivariable analysis was used to adjust for hospital, maternal age, race/ethnicity, body mass index, cigarette use, and insurance status.

RESULTS: We found 31,169 women who met our criteria. Neonatal complications were either less frequent with nonmedically indicated induction or no different between groups. Nonmedically indicated induction was associated with less frequent peripartum infections (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.16-0.98) at 38 weeks of gestation and less frequent third- and fourth-degree lacerations (OR, 0.60; 95% CI, 0.42-0.86) and less frequent peripartum infections (OR, 0.66; 95% CI, 0.49-0.90) at 39 weeks of gestation. Nonmedically indicated induction was associated with a longer admission-to-delivery time by approximately 3-4 hours and increased odds of cesarean delivery at 38 (OR, 1.50; 95% CI, 1.08-2.08) and 40 weeks (OR, 1.30; 95% CI, 1.15-1.46) of gestation.

CONCLUSION: At 39 weeks of gestation, nonmedically indicated induction is associated with lower maternal and neonatal morbidity than women who are expectantly treated.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume212
Issue number1
DOIs
StatePublished - Jan 1 2015

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Odds Ratio
Confidence Intervals
Pregnancy
Mothers
Peripartum Period
Therapeutics
Insurance Coverage
Lacerations
Maternal Age
Infection
Tobacco Products
Body Mass Index
Morbidity

Keywords

  • induction
  • nonmedically indicated induction
  • nulliparous women

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network (2015). Nonmedically indicated induction vs expectant treatment in term nulliparous women. American Journal of Obstetrics and Gynecology, 212(1). https://doi.org/10.1016/j.ajog.2014.06.054

Nonmedically indicated induction vs expectant treatment in term nulliparous women. / Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network.

In: American Journal of Obstetrics and Gynecology, Vol. 212, No. 1, 01.01.2015.

Research output: Contribution to journalArticle

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network 2015, 'Nonmedically indicated induction vs expectant treatment in term nulliparous women', American Journal of Obstetrics and Gynecology, vol. 212, no. 1. https://doi.org/10.1016/j.ajog.2014.06.054
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. American Journal of Obstetrics and Gynecology. 2015 Jan 1;212(1). https://doi.org/10.1016/j.ajog.2014.06.054
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. In: American Journal of Obstetrics and Gynecology. 2015 ; Vol. 212, No. 1.
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