Trends in labor induction and perinatal outcomes: A decade comparison before and after the ARRIVE trial

This study aimed to compare maternal characteristics, delivery outcomes, and neonatal conditions in 2013 and 2023 at our hospital and to evaluate the association between labor induction and neonatal outcomes.

A retrospective cohort study was conducted, including 600 women who delivered in 2013 (n = 316) and 2023 (n = 284). Cases involving scheduled cesarean delivery, vaginal birth after cesarean, missing data, or immediate neonatal death were excluded. Maternal demographics, obstetric parameters, and neonatal outcomes were compared. Logistic regression was performed to assess the association between induction of labor and adverse outcomes.

The mean maternal age increased significantly from 29.73 to 31.29 years (P < 0.001), and the induction rate more than doubled from 19.94% to 50.70% (P < 0.001). Although cesarean rates were unchanged, vacuum extraction deliveries increased (15.82% vs. 27.46%, P < 0.001), and spontaneous vaginal deliveries decreased (80.70% vs. 68.31%, P < 0.001). Neonatal intensive care unit (NICU) admissions rose significantly (2.53% vs. 7.39%, P < 0.001), while low 1-min Apgar scores (≤6) remained stable. Regression and sensitivity analyses revealed that induction of labor was independently associated with a higher risk of low Apgar scores (adjusted odds ratio = 3.24, 95% confidence interval = 1.27-8.28, P = 0.014), but not with increased rates of NICU admission or vacuum-assisted delivery.

Over the past decade, both maternal age and labor induction rates have increased markedly. While cesarean rates remained steady, induction of labor was associated with greater neonatal morbidity, reflected by increased low Apgar scores. These findings emphasize the need for careful clinical judgment and close monitoring during labor induction to optimize perinatal outcomes.