Cesarean during labor: Is induction a risk factor for complications?

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Outcomes Research

Background:

• Cesarean sections during labor are common.
• Understanding factors influencing maternal complications is crucial for improving obstetric care.
• Labor induction is a frequent intervention preceding cesarean delivery.

Purpose of the Study:

• To evaluate the impact of labor induction on maternal complications after cesarean section during labor.
• To compare complications between spontaneous labor and induced labor groups.
• To analyze complications based on the method of labor induction used.

Main Methods:

• Retrospective, single-center study (2015-2017) of singleton pregnancies undergoing cesarean section after 37 weeks.
• Labor induction methods included transcervical balloon catheters or prostaglandins.
• Cesarean emergency degree categorized by color code (green, orange, red).
• Intraoperative and postoperative complications were compared based on labor onset and induction method.

Main Results:

• 882 patients included: 416 spontaneous labor, 464 labor induction.
• No significant difference in overall postoperative complications between spontaneous and induced labor groups.
• Spontaneous labor group had more uterine pedicle injuries (6.3% vs. 3.0%), while elective induction had more green-code cesareans (40.3% vs. 29.3%).
• No difference in postpartum hemorrhage (PPH) rates (41.59% vs. 43.32%).
• Subgroup analysis: two induction methods increased severe PPH risk (22.2% vs. 8.1%).

Conclusions:

• Elective labor induction does not elevate the risk of complications during cesarean section.
• The combination of prostaglandin following a transcervical balloon catheter for labor induction is associated with an increased risk of severe postpartum hemorrhage.
• Further research may explore optimal induction protocols to mitigate PPH risks.