Clinical Outcomes of Term Elective Induction of Labor With Unripe Cervix [34N]

Abstract

INTRODUCTION: Elective induction of labor has increased over time resulting in higher cesarean delivery rates. Maternal and neonatal outcomes of pregnancies undergoing pre-induction cervical ripening at 39 weeks were compared with those induced at later gestational ages. METHODS: Retrospective cohort study of singleton pregnancies induced without a medical indication and a Bishop score less than 8 or simplified Bishop score less than 5 at 39 0/7-6/7, 40 0/7-6/7, and 41 0/7-6/7 weeks between 2006 and 2015. Specific individual maternal and neonatal outcomes were compared. Chi-square, One-way ANOVA, and Fisher exact test were used for statistical analysis. RESULTS: Of the 718 identified pregnancies, 143 (19.9%) were induced at 39 weeks, 240 (33.4%) at 40 weeks, and 335 (46.6%) at 41 weeks. Nulliparity was significantly higher in the 41-week group than in the 40-, and the 39-week groups (78.8%, 64.5%, and 37.7%, respectively; P < .00001). Among nulliparous women, cesarean delivery was significantly lower at 39 weeks (27.7%) than at 40 weeks (34.4%), and at 41 weeks (47.7%) (P=.0003). Conversely, cesarean delivery rate was low and not significantly different among multiparous women at each of the gestational age groups. Postpartum hemorrhage and chorioamnionitis rates were significantly higher at 41 weeks compared with the other groups (all P < .0001). NICU admission, 5-minute Apgar scores less than 7, respiratory distress syndrome, and neonatal death rates did not differ significantly among the groups. CONCLUSION: Elective induction of labor at 39 weeks with unfavorable cervix was associated with favorable maternal outcomes and low cesarean delivery rate.