Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar;99(3):406-412.
doi: 10.1111/aogs.13751. Epub 2019 Nov 19.

Target populations to reduce cesarean rates after induced labor: A national population-based cohort study

Pauline Blanc-Petitjean  1   2 , Thomas Schmitz  1   3 , Marina Salomé  4 , François Goffinet  1   5 , Camille Le Ray  1   5 ; MEDIP Study Group
Affiliations
Free article

Target populations to reduce cesarean rates after induced labor: A national population-based cohort study

Pauline Blanc-Petitjean et al. Acta Obstet Gynecol Scand. 2020 Mar.
Free article

Abstract

Introduction: Great variations in cesarean rates after induction of labor exist and reasons for these disparities remain unclear. They may be explained by individual characteristics or obstetric practices. Ten-group classification systems have proved their utility to monitor cesarean rates in general population. We aimed to identify groups of women that account for most cesareans after induction of labor using the Nippita reproducible 10-group classification, specifically designed for induced population.

Material and methods: A prospective population-based cohort study was performed in 94 French maternity units, including 3042 women undergoing induction of labor. Women were sorted according to 10 mutually exclusive groups based on parity, weeks of gestation, number of fetuses, fetal presentation and previous cesarean delivery. Relative size, cesarean delivery rate and contribution to the overall cesarean rate were described for each group. Cesarean rates were compared according to the Bishop score at the onset of labor induction. Indications for cesarean delivery were also described in the groups that contributed most to the overall cesarean rate. The MEDIP protocol was registered in ClinicalTrial (NCT02477085).

Results: The overall cesarean rate was 21.0% among this population of induced women. Nulliparous women with a term singleton cephalic fetus (groups 1, 2 and 3; at 37-38, 39-40 and ≥41 weeks of gestation, respectively) accounted for two-thirds of the overall cesarean rate because they were the largest group (relative size of 10.6, 16.6 and 18.1%, respectively) and had higher cesarean rates (27.2, 30.9 and 33.0%, respectively). When the Bishop score was <6 (n = 2270/3042), cesarean delivery rates were higher (24.1 vs 10.7% if Bishop score ≥6, P < 0.01), in particular for group 1 (29.1 vs 12.5%, P = 0.02), and group 2 (33.3 vs 19.3%, P = 0.01). In groups 1, 2 and 3, which contributed most to the overall cesarean rate, a significant part of the cesareans were performed before 6 cm of cervical dilation for dystocia only (40.0, 16.7 and 17.6%, respectively).

Conclusions: Nulliparous women with a term singleton cephalic fetus and an unfavorable cervix represent the population to target for auditing induction practices. Specific actions could be implemented among this population to weigh the benefits and risks of induction and improve the management of labor induction.

Keywords: Bishop score; audit; cesarean; classification; failed induction of labor; induced labor.

PubMed Disclaimer

References

REFERENCES

    1. Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep. 2015;64(12):1-64.
    1. Euro-Peristat Project with SCPE and EUROCAT, European perinatal health report, Health and Care of Pregnant Women and Babies in Europe in 2010. http://www.europeristat.com/reports/european-perinatal-health-report-201... 2013 [accessed 25 March 2017].
    1. Blondel B, Coulm B, Bonnet C, Goffinet F, Le Ray C; National Coordination Group of the National Perinatal Surveys. Trends in perinatal health in metropolitan France from 1995 to 2016: results from the French National Perinatal Surveys. J Gynecol Obstet Human Reprod. 2017;46:701-713.
    1. Le Ray C, Blondel B, Prunet C, Khireddine I, Deneux-Tharaux C, Goffinet F. Stabilising the caesarean rate: which target population? BJOG. 2015;122:690-699.
    1. Pyykönen A, Gissler M, Løkkegaard E, et al. Cesarean section trends in the Nordic Countries-a comparative analysis with the Robson classification. Acta Obstet Gynecol Scand. 2017;96:607-616.

Publication types

Associated data