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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

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Quantifying the Risks and Benefits of Continuing Labor Induction: Data for Shared Decision-Making.

Elizabeth Nicole Teal¹, Adam K Lewkowitz², Sarah L P Koser¹

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.

American Journal of Perinatology

|February 5, 2020

Summary

Continuing labor induction beyond 24 hours may decrease vaginal delivery chances and increase maternal risks like hemorrhage and infection, though neonatal outcomes remain unaffected. These findings aid shared decision-making in labor induction.

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Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine
Clinical Obstetrics

Background:

Labor induction is a common obstetric intervention.
Quantifying risks and benefits of prolonged labor induction is crucial for informed decision-making.

Purpose of the Study:

To quantify the relative maternal and fetal risks and benefits of continuing labor induction.
To analyze the association between labor induction duration and delivery outcomes, including maternal morbidity and neonatal morbidity.

Main Methods:

Retrospective cohort study of nulliparous women with term, singleton, vertex pregnancies undergoing labor induction.
Analysis included primary outcome (mode of delivery) and secondary outcomes (hemorrhage, transfusion, infection, neonatal morbidity).
Statistical methods included chi-square tests, Fisher's exact tests, and multivariable regression to control for confounders.

Main Results:

A total of 955 patients were included; median induction duration was 32.3 hours.
Vaginal delivery rate was 70.5%; induction beyond 24 hours was associated with a 20% decrease in vaginal delivery chance.
Adjusted relative risks for hemorrhage, transfusion, and infection increased with induction duration beyond 24 hours, but these risks were primarily in cesarean delivery patients; no association with neonatal morbidity was found.

Conclusions:

Vaginal delivery remains possible even with prolonged induction (>60 hours).
Maternal risks of hemorrhage and infection increase modestly with prolonged induction, particularly in those undergoing cesarean delivery.
No increased risk of transfusion beyond 24 hours and no association with neonatal morbidity suggest careful consideration of induction duration in shared decision-making.