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Elective Induction Compared With Expectant Management in Nulliparous Women With a Favorable Cervix

Osmundson, Sarah S. MD; Ou-Yang, Robin J. MD; Grobman, William A. MBA

doi: 10.1097/AOG.0b013e3181eb6e9b
Original Research

OBJECTIVE: To compare outcomes of labor between nulliparous women with a favorable cervix who underwent either elective labor induction or expectant management beyond 39 weeks of gestation.

METHODS: A retrospective cohort study was conducted of nulliparous women with a singleton gestation who had a favorable cervix (modified Bishop score of at least 5) and delivered between 2006 and 2008. Two hundred ninety-four nulliparous women who underwent elective induction of labor between 39 and 40 5/7 weeks of gestation were compared with 294 nulliparous women who were expectantly managed beyond 39 weeks of gestation.

RESULTS: The primary outcome, cesarean delivery, was similar between the two groups (20.8% compared with 20.1%, respectively, P=.84), a result that did not change in multivariable analysis. There were also no significant differences in other maternal (eg, chorioamnionitis, meconium, operative vaginal delivery, third- and fourth-degree lacerations, postpartum hemorrhage), or neonatal (arterial cord pH less than 7.0, Apgar score less than 4 at 5 minutes, neonatal intensive care unit admission) outcomes. Women who underwent an elective labor induction did have longer duration in labor and delivery between admission and delivery (median 12.7 compared with 9.0 hours, P<.001).

CONCLUSION: For nulliparous women with a favorable cervix, elective labor induction has a similar chance of resulting in cesarean delivery as expectant management, although it appears to result in an increase in resource use.

LEVEL OF EVIDENCE: II

Elective induction of labor in women with a favorable cervix does not increase the cesarean delivery rate but does increase use of labor and delivery resources.

From the Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Corresponding author: Sarah Osmundson, MD, 250 East Superior, Suite 05-2175, Chicago, IL 60611; e-mail: s.osmundson@gmail.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists.