Elective induction of labor statistics
March 21, 2011
In March of 2009, the Agency for Research, Healthcare and Qulaity published the evidence-based report about the Maternal and Neonatal Outcomes of Elective Induction of Labor. This Stanford-UCSF Practice Center examined the evidence regarding four Key Questions: 1) What evidence describes the maternal risks of elective induction versus expectant management? 2) What evidence describes the fetal/neonatal risks of elective induction versus expectant management? 3) What is the evidence that certain physical conditions/patient characteristics are predictive of a successful induction of labor? and 4) How is a failed induction defined?
After a Medline search from 1966-2007, they reviewed 3,372 potentially relevant articles. In studies of women at or beyond 41 weeks of gestation, the evidence was rated as moderate due to of the size and number of the studies and consistency of the findings -higher rates possibly due to increased number of meconium-stained fluid and macrosomia? The evidence regarding elective induction of labor prior to 41 weeks of gestation is insufficient to draw any conclusion.
Observational studies reported a consistently lower risk of cesarean delivery among women who underwent spontaneous labor (6 percent) compared with women who had an elective induction of labor (8 percent). Observational studies also found higher rates of cesarean delivery with elective induction of labor.
Interestingly, Obesity is found to have a higher rate of failure. There are several studies which examined the association of body-mass index and cesarean delivery in the setting of induction of labor. When maternal BMI was dichotomized at 30kg/m2, the authors found that those women with a higher BMI had higher rates of cesarean delivery in the setting of induction of labor. The presumed biologic plausibility behind this association includes higher rates of pregnancy-related complications such as preeclampsia, gestational diabetes, and increased birthweight with associated risks such as shoulder dystocia. These factors are associated with maternal obesity leading to higher rates of cephalo-pelvic disproportion and cesarean deliveries.
In summary, trusting your body to be physically at it’s best to prepare for the “marathon of labor” can decrease the amount of intervention and surgery in the long run…literally.