Elective inductions harmful to first-time mothers, babies

Elective induction in nulliparas is associated with increased rates of cesarean delivery, postpartum hemorrhage, neonatal resuscitation, and longer hospital stays without any benefit to the neonate, according to the findings of a recent retrospective review.

Researchers reviewed the charts of nulliparous women with singleton gestations delivering in 2007. They defined elective induction as occurring between 37 weeks 0/7 days and 41 weeks 0/7 days without ruptured membranes, fetal/maternal complications, or abnormal fetal testing.

Of the 485 women included in the study, 19.8% of the labor group and 33.6% of the induction group required a cesarean delivery. The odds ratio for cesarean delivery was 2.1 (P=0.001) or 1.8 after adjusting for gestational age and birth weight (P=0.01).

Rates of epidural, postpartum hemorrhage, pediatric delivery attendance, and neonatal oxygen requirement all were higher with induction, before and after adjustment.

A strength of the study is that the researchers reviewed maternal and pediatric charts rather than relying on medical coding, so that they could catch subtle details surrounding why induction took place and what, if any, complications occurred. The researchers cautioned that the findings apply only to first-time mothers and may not pertain to women having subsequent children.

Vardo JH, Thornburg LL, Glantz JC. Maternal and neonatal morbidity among nulliparous women undergoing elective induction of labor. J Reprod Med. 2011;56(1-2):25-30.