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Elective Induction of Labor in the 39th Week of Gestation Compared With Expectant Management of Low-Risk Multiparous Women

Sinkey, Rachel G. MD; Blanchard, Christina T. MS; Szychowski, Jeff M. PhD; Ausbeck, Elizabeth MD; Subramaniam, Akila MD, MPH; Neely, Cherry L.; Casey, Brian M. MD; Tita, Alan T. MD, PhD

doi: 10.1097/AOG.0000000000003371
Contents: Obstetrics: Original Research
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OBJECTIVE: To compare perinatal and maternal outcomes in low-risk multiparous women who underwent elective induction of labor in the 39th week of gestation with those who were expectantly managed.

METHODS: We performed a single center retrospective cohort study of low-risk multiparous women delivering nonanomalous singletons between 39 and 42 completed weeks of gestation from 2014 to 2018. The primary outcome was a perinatal composite of death, neonatal respiratory support, a 5-minute Apgar score of 3 or less, and shoulder dystocia. Groups were compared using χ2, Fisher exact, two sample t-test, and Wilcoxon rank sum tests, as appropriate. Multivariable logistic regression models were used to adjust for potential confounders.

RESULTS: Of the 3,703 low-risk multiparous women meeting inclusion criteria, 453 (12%) delivered between 39 0/7 and 39 4/7 after an elective induction of labor. Women who underwent elective induction of labor were more likely to be privately insured, non-Hispanic, and weigh more at their first prenatal visit (all P<.01) compared with expectant management. An elective induction of labor was associated with decreased frequency of the perinatal composite morbidity (4.0% vs 7.1%; adjusted odds ratio [aOR] 0.57, 95% CI 0.34–0.96) compared with expectant management. Fewer cesarean deliveries occurred among women in the elective induction of labor group (5.1% vs 6.6%; aOR 0.60, 95% CI 0.37–0.97). Other maternal outcomes (hypertensive disorders, chorioamnionitis, and operative vaginal deliveries) as well as neonatal intensive care unit admissions were not different between groups.

CONCLUSION: Elective induction of labor in low-risk multiparous women in the 39th week of gestation was associated with decreased perinatal morbidity and a lower frequency of cesarean delivery compared with expectant management.

Elective induction of labor in low-risk multiparous women in the 39th week of gestation was associated with decreased perinatal morbidity and fewer cesarean deliveries compared with expectant management.

Center for Women's Reproductive Health and the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.

Corresponding author: Rachel G. Sinkey, MD, University of Alabama at Birmingham, Birmingham, AL; email: rsinkey@uabmc.edu.

Financial Disclosure Rachel G. Sinkey received money paid to her intuition from PROM Complete. The other authors did not report any potential conflicts of interest.

Presented at the Society for Maternal-Fetal Medicine's 39th annual meeting, February 11–16, 2019, Las Vegas, Nevada.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews are available at http://links.lww.com/AOG/B451.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.