Induction of labor for nulliparas with favorable cervix?

January 01, 0001

Induction of labor for nulliparas with favorable cervix?

These US authors compared the duration and complications of the second stage of labor between women in induced and spontaneous labor. This was a retrospective cohort study of women with singleton term gestations who reached full dilation at a single institution from 2001 through 2009. Second- stage duration, mode of delivery, and complication rates were compared between women in induced and spontaneous labor using survival analysis, univariable analysis, and multivariable analyses to control for potential confounders.

They found: "We identified 14,727 women who reached the second stage; 3,139 (21.3%) were induced and 11,588 (78.7%) were in spontaneous labor. After adjusting for confounders (maternal age, body mass index, epidural use, gestational age, midwifery care, health center care, year of delivery), there was no difference in length of the second stage or risk of a prolonged second stage between women in induced and spontaneous labor. In both groups, risk of complications increased with duration of the second stage, including chorioamnionitis, postpartum hemorrhage, third- or fourth-degree laceration, operative vaginal delivery, and 5-minute Apgar score less than 7. Among nulliparas who reached full dilation, our data suggested an increased odds of cesarean (10.9% compared with 7.2%, adjusted OR 1.32) and postpartum hemorrhage (4.2% compared with 2.0%, adjusted OR 1.62) with induction. There was no difference in mode of delivery or rates of complications among multiparas."

The authors concluded: "Among women who reach full dilation, labor proceeds similarly regardless of induction status. Induced nulliparas may have an increased risk of hemorrhage and cesarean delivery."

Spontaneous labor appears preferable for nulliparous women with favorable cervix at term pregnancy.

For the full abstract, click here.

Obstet Gynecol 116(3):606-611, September 2010 © 2010 to the American College of Obstetricians and Gynecologists
Comparing the Second Stage in Induced and Spontaneous Labor. Vanitha Janakiraman, Jeffrey Ecker, Anjali J. Kaimal. Correspondence to Dr. Janakiraman: [email protected]

Category: W. Pregnancy, Childbirth, Family Planning. Keywords: labor, induction, nulliparas, term pregnancy, retrospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 3 September 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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