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Trends in labor induction indications: A 20-year population-based study.

Emma M Swift1,2, Johanna Gunnarsdottir3,4,5, Helga Zoega3,6

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Acta Obstetricia Et Gynecologica Scandinavica
|September 17, 2022
PubMed
Summary

Labor induction rates have significantly increased, primarily due to rising medical indications like gestational diabetes and hypertensive disorders. However, a small percentage of inductions still lack clear reasons, requiring further study.

Keywords:
electiveepidemiologyindicationlabor inductionmaternal request

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal Health
  • Public Health

Background:

  • Labor induction rates have risen substantially in middle- and high-income countries over the last decade.
  • The underlying drivers for this increase in labor induction are not well understood.
  • This study investigates the extent to which changes in indications explain the rising rate of labor induction.

Purpose of the Study:

  • To assess the contribution of changing indications to the increasing rate of labor induction.
  • To identify specific medical conditions that have become more frequent reasons for induction.
  • To determine the proportion of labor inductions with unexplained indications over time.

Main Methods:

  • Analysis of nationwide data from the Icelandic Medical Birth Register (1997-2018).
  • Inclusion of 85,620 singleton births.
  • Calculation of labor induction rates and indications using Poisson regression, adjusted for maternal characteristics and indications.

Main Results:

  • The crude rate of labor induction increased from 12.5% to 23.9% between 1997-2001 and 2014-2018.
  • Adjusting for indications reduced the relative risk of induction increase from 1.91 to 1.43.
  • Key increasing indications included gestational diabetes, hypertensive disorders, prolonged pregnancy, maternal well-being concerns, and advanced maternal age.
  • Unexplained indications decreased from 16.3% to 9.2% but remain significant.

Conclusions:

  • The rise in labor induction is largely attributable to an increase in documented medical indications.
  • Despite this, a notable proportion of labor inductions (9.2%) in recent years lack clear recorded indications.
  • Further research is needed to understand the reasons behind unexplained labor inductions.