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Comparative Study
. 2009 Nov;18(11):1747-58.
doi: 10.1089/jwh.2007.0449.

The association between increased use of labor induction and reduced rate of cesarean delivery

James M Nicholson  1 , Peter Cronholm, Lisa C Kellar, Morghan H Stenson, George A Macones
Affiliations
Comparative Study

The association between increased use of labor induction and reduced rate of cesarean delivery

James M Nicholson et al. J Womens Health (Larchmt). 2009 Nov.

Abstract

Aim: An association was recently reported between a low cesarean section delivery rate and a method of obstetrical care that involved the frequent use of risk-guided prostaglandin-assisted preventive labor induction. We sought to confirm this finding in a subsequent group of pregnant women.

Methods: A retrospective cohort study design was used to compare the outcomes of 100 consecutively delivered women, who were exposed to the alternative method of care, with the outcomes of 300 randomly chosen women who received standard management. The primary outcome was group cesarean delivery rate. Secondary outcomes were rates of neonatal intensive care unit admission, low 1-minute Apgar score, low 5-minute Apgar score, and major perineal trauma.

Results: Women exposed to the alternative method of obstetrical care had a higher induction rate (59% vs. 16.3%, p < 0.001), a more frequent use of prostaglandins for cervical ripening (32% vs. 13%, p < 0.001), and a lower cesarean delivery rate (7% vs. 20.3%, p = 0.002). Exposed women did not experience higher rates of other adverse birth outcomes.

Conclusions: Exposure to an alternative method of obstetrical care that used high levels of risk-driven prostaglandin-assisted labor was again associated with two findings: a lower group cesarean delivery rate and no increases in levels of other adverse birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.

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Figures

FIG. 1.
FIG. 1.
(A) Distribution of timing of delivery as a function of gestational age, by study groups. (B) Spontaneous vs. induced labor as a function of gestational age, by study group. (C) Vaginal vs. cesarean delivery as a function of gestational age, by study group.
See this image and copyright information in PMC

Comment in

References

    1. Hamilton BE. Martin JA. Ventura SJ. National vital statistics reports. 7. Vol. 56. Hyattsville, MD: National Center for Health Statistics; 2007. Births: Preliminary data for 2006.
    1. Ecker JL. Frigoletto FD., Jr Cesarean delivery and the risk-benefit calculus. N Engl J Med. 2007;356:885–888. - PubMed
    1. Bailit JL. Love TE. Mercer B. Rising cesarean rates: Are patients sicker? Am J Obstet Gynecol. 2004;191:800–803. - PubMed
    1. Declercq E. Menacker F. Macdorman M. Maternal risk profiles and the primary cesarean rate in the United States, 1991–2002. Am J Public Health. 2006;96:867–872. - PMC - PubMed
    1. Healthy people 2000. National health promotion and disease prevention objectives: Full report, with commentary. Government Printing Office. Vol. 378. Washington, DC: 1990. pp. 91–50212. DHHS publication No. (PHS).

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