Randomized Controlled Trial

. 2020 Apr;222(4):369.e1-369.e11.

doi: 10.1016/j.ajog.2020.01.002. Epub 2020 Jan 10.

Health resource utilization of labor induction versus expectant management

William A Grobman¹, Grecio Sandoval², Uma M Reddy³, Alan T N Tita⁴, Robert M Silver⁵, Gail Mallett⁶, Kim Hill⁵, Madeline Murguia Rice², Yasser Y El-Sayed⁷, Ronald J Wapner⁸, Dwight J Rouse⁹, George R Saade¹⁰, John M Thorp Jr¹¹, Suneet P Chauhan¹², Jay D Iams¹³, Edward K Chien¹⁴, Brian M Casey¹⁵, Ronald S Gibbs¹⁶, Sindhu K Srinivas¹⁷, Geeta K Swamy¹⁸, Hyagriv N Simhan¹⁹, George A Macones²⁰; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network

Collaborators, Affiliations

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network:
A Peaceman, B Plunkett, K Paycheck, M Dinsmoor, S Harris, J Sheppard, J Biggio, L Harper, S Longo, C Servay, M Varner, A Sowles, K Coleman, D Atkinson, J Stratford, S Dellermann, C Meadows, S Esplin, C Martin, K Peterson, S Stradling, C Willson, D Lyell, A Girsen, R Knapp, C Gyamfi, S Bousleiman, A Perez-Delboy, M Talucci, V Carmona, L Plante, C Tocci, B Leopanto, M Hoffman, L Dill-Grant, K Palomares, S Otarola, D Skupski, R Chan, D Allard, T Gelsomino, J Rousseau, L Beati, J Milano, E Werner, A Salazar, M Costantine, G Chiossi, L Pacheco, A Saad, M Munn, S Jain, S Clark, K Clark, K Boggess, S Timlin, K Eichelberger, A Moore, C Beamon, H Byers, F Ortiz, L Garcia, B Sibai, A Bartholomew, C Buhimschi, M Landon, F Johnson, L Webb, D McKenna, K Fennig, K Snow, M Habli, M McClellan, C Lindeman, W Dalton, D Hackney, H Cozart, A Mayle, B Mercer, L Moseley, J Gerald, L Fay-Randall, M Garcia, A Sias, J Price, K Hale, J Phipers, K Heyborne, J Craig, S Parry, H Sehdev, T Bishop, J Ferrara, M Bickus, S Caritis, E Thom, L Doherty, J de Voest

Affiliations

¹ Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL. Electronic address: w-grobman@northwestern.edu.
² George Washington University Biostatistics Center, Washington, DC.
³ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁴ University of Alabama at Birmingham, Birmingham, AL.
⁵ University of Utah Health Sciences Center, Salt Lake City, UT.
⁶ Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL.
⁷ Stanford University, Stanford, CA.
⁸ Columbia University, New York, NY.
⁹ Brown University, Providence, RI.
¹⁰ University of Texas Medical Branch, Galveston, TX.
¹¹ University of North Carolina at Chapel Hill, Chapel Hill, NC.
¹² University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
¹³ Ohio State University, Columbus, OH.
¹⁴ MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH.
¹⁵ University of Texas Southwestern Medical Center, Dallas, TX.
¹⁶ University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
¹⁷ University of Pennsylvania, Philadelphia, PA.
¹⁸ Duke University, Durham, NC.
¹⁹ University of Pittsburgh, Pittsburgh, PA.
²⁰ Washington University, Saint Louis, MO.

PMID: 31930993
PMCID: PMC7141954
DOI: 10.1016/j.ajog.2020.01.002

Randomized Controlled Trial

Health resource utilization of labor induction versus expectant management

William A Grobman et al. Am J Obstet Gynecol. 2020 Apr.

. 2020 Apr;222(4):369.e1-369.e11.

doi: 10.1016/j.ajog.2020.01.002. Epub 2020 Jan 10.

Authors

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network:
A Peaceman, B Plunkett, K Paycheck, M Dinsmoor, S Harris, J Sheppard, J Biggio, L Harper, S Longo, C Servay, M Varner, A Sowles, K Coleman, D Atkinson, J Stratford, S Dellermann, C Meadows, S Esplin, C Martin, K Peterson, S Stradling, C Willson, D Lyell, A Girsen, R Knapp, C Gyamfi, S Bousleiman, A Perez-Delboy, M Talucci, V Carmona, L Plante, C Tocci, B Leopanto, M Hoffman, L Dill-Grant, K Palomares, S Otarola, D Skupski, R Chan, D Allard, T Gelsomino, J Rousseau, L Beati, J Milano, E Werner, A Salazar, M Costantine, G Chiossi, L Pacheco, A Saad, M Munn, S Jain, S Clark, K Clark, K Boggess, S Timlin, K Eichelberger, A Moore, C Beamon, H Byers, F Ortiz, L Garcia, B Sibai, A Bartholomew, C Buhimschi, M Landon, F Johnson, L Webb, D McKenna, K Fennig, K Snow, M Habli, M McClellan, C Lindeman, W Dalton, D Hackney, H Cozart, A Mayle, B Mercer, L Moseley, J Gerald, L Fay-Randall, M Garcia, A Sias, J Price, K Hale, J Phipers, K Heyborne, J Craig, S Parry, H Sehdev, T Bishop, J Ferrara, M Bickus, S Caritis, E Thom, L Doherty, J de Voest

Affiliations

¹ Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL. Electronic address: w-grobman@northwestern.edu.
² George Washington University Biostatistics Center, Washington, DC.
³ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁴ University of Alabama at Birmingham, Birmingham, AL.
⁵ University of Utah Health Sciences Center, Salt Lake City, UT.
⁶ Departments of Obstetrics and Gynecology, Northwestern University, Chicago, IL.
⁷ Stanford University, Stanford, CA.
⁸ Columbia University, New York, NY.
⁹ Brown University, Providence, RI.
¹⁰ University of Texas Medical Branch, Galveston, TX.
¹¹ University of North Carolina at Chapel Hill, Chapel Hill, NC.
¹² University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX.
¹³ Ohio State University, Columbus, OH.
¹⁴ MetroHealth Medical Center-Case Western Reserve University, Cleveland, OH.
¹⁵ University of Texas Southwestern Medical Center, Dallas, TX.
¹⁶ University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO.
¹⁷ University of Pennsylvania, Philadelphia, PA.
¹⁸ Duke University, Durham, NC.
¹⁹ University of Pittsburgh, Pittsburgh, PA.
²⁰ Washington University, Saint Louis, MO.

PMID: 31930993
PMCID: PMC7141954
DOI: 10.1016/j.ajog.2020.01.002

Abstract

Background: Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization.

Objective: The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum.

Study design: This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum.

Results: Of 6096 women with data available, those in the induction of labor group (n = 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P = .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all).

Conclusion: Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.

Keywords: cesarean delivery; costs; expectant management; induction of labor; resources.

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Conflict of interest statement

The authors have no conflicts of interest

References

1. Grobman WA, Rice MM, Reddy UM, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med 2018;379:513–23. - PMC - PubMed
1. American College of Obstetricians and Gynecologists. Practice Advisory: Clinical guidance for integration of the findings of The ARRIVE Trial: Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisor.... Retrieved November 20, 2018.
1. SMFM Statement on Elective Induction of Labor in Low-Risk Nulliparous Women at Term: the ARRIVE Trial. Society of Maternal-Fetal (SMFM) Publications Committee. Am J Obstet Gynecol. 2018. August 9 pii: S0002–9378(18)30661–6. doi: 10.1016/j.ajog.2018.08.009. - DOI - PubMed
1. Van Gemund N, Hardeman A, Scherjon SA, Kanhai HHH. Intervention rates after elective induction of labor compared to labor with a spontaneous onset. Gynecol Obstet Invest 20013;56:133–8. - PubMed
1. Seyb ST, Berka RJ, Socol MS, Dooley SL. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol 1999;94:600–7. - PubMed

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Health resource utilization of labor induction versus expectant management

Collaborators

Affiliations

Health resource utilization of labor induction versus expectant management

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

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