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Maternal and Neonatal Outcome Following Prolonged Labor Induction

Obstetrics & Gynecology: September 1998
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Objective To examine the effect of labor induction length on maternal and neonatal outcome.

Methods Inductions of labor were reviewed retrospectively, comparing 27 patients with infectious complications to 313 with no infections. Univariate analysis, t-test, χ2, and Fisher exact test were used for statistical analysis. Forward stepping logistic regression was used in a multivariate model to identify odds ratio (OR) and 95% confidence intervals (CI).

Results There was a statistically significant increased risk of maternal infection with increasing induction time. In univariate analysis, cesarean delivery, duration of induction, duration of oxytocin administration, nulliparity, use of internal monitors, increased maternal weight gain, and low cervical dilatation at start of induction were all associated with increased maternal infection risk. Multivariate analysis showed duration of induction for each additional 2 hours (OR 1.09;95% CI 1.01, 1.18) and nonwhite ethnicity (OR 5.95; 95% CI 1.72, 20.49) to be associated significantly with maternal infection. Maternal infection was associated with lower Apgar scores and increased neonatal intensive care unit admissions. In patients who delivered vaginally, a logistic regression model estimated infectious morbidity at 40 hours to be 10%. The cesarean rate was not increased with prolonged induction.

Conclusion Prolonged induction is associated with a small increased risk of infectious morbidity, with an estimated 10% incidence noted after 40 hours of induction in women who deliver vaginally.

Address reprint requests to: John D. Jacobson, MD, Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Room 3401, Loma Linda, CA 92354. E-mail:

© 1998 The American College of Obstetricians and Gynecologists

Prolonged labor induction is associated with a small increase in infectious morbidity and does not increase the cesarean rate.