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. 2022 Jun 1;22(1):463.
doi: 10.1186/s12884-022-04760-6.

Labor induction in China: a nationwide survey

Jing Zhu #  1   2 , Lili Xue #  3 , Huaxiang Shen  3 , Lin Zhang  1 , Danni Lu  2 , Yanlin Wang  1 , Yu Zhang  4 , Jun Zhang  5
Affiliations

Labor induction in China: a nationwide survey

Jing Zhu et al. BMC Pregnancy Childbirth. .

Abstract

Background: Overmedicalization in labor management and delivery, including labor induction, is an increasing global concern. But detailed epidemiological data on labor induction in China remains unclear.

Methods: This was a cross-sectional study of data (2015-2016) from 96 hospitals in 24 (of 34) Chinese administrative divisions. Multivariable logistic regression analysis was used to assess the association between medical conditions and cesarean delivery among women undergoing induction. Linear regression analysis was performed to assess the association between the prelabor cesarean delivery and labor-induction rates in each hospital. The impacts of labor induction and prelabor cesarean delivery on maternal and neonatal outcomes were compared in low-risk women.

Results: Among 73 901 eligible participants, 48.1% were nulliparous. The overall weighted rate of labor induction in China was 14.2% (95% CI, 11.1-17.2%), with 18.4% (95% CI, 14.5-22.3%) in nulliparas and 10.2% (95% CI, 7.7-12.8%) in multiparas. Regardless of the induction method, the overall vaginal delivery rate was 72.9% (95% CI, 68.6-77.3%) in nulliparas and 86.6% (95% CI, 79.7-93.5%) in multiparas. Hospitals with a higher rate of nonmedically indicated cesarean delivery had a lower labor-induction rate in nulliparas (β = - 0.57%; 95% CI, - 0.92 to - 0.22%; P = 0.002). Compared with prelabor cesarean delivery, labor induction in low-risk women was not associated with adverse maternal and neonatal outcomes.

Conclusion: The 2015-2016 labor-induction rate in China was 18.4% in nulliparas and 10.2% in multiparas. The proportion of prelabor cesarean delivery may contribute to regional differences in the labor-induction rate. Compared with prelabor cesarean delivery, labor induction in low-risk women may not increase severe maternal and neonatal morbidity.

Keywords: Epidemiology; Labor induction; Obstetrics.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of labor induction by weeks of gestation
Fig. 2
Fig. 2
Vaginal delivery rate among women undergoing labor induction
Fig. 3
Fig. 3
Vaginal delivery rate among women undergoing labor induction with various medical indications. A Nulliparous women. B Multiparous women. SGA, small for gestational age; PROM, premature rupture of membrane
Fig. 4
Fig. 4
Attempted mode of delivery by geographical regions in China. A Nulliparous women. B Multiparous women
See this image and copyright information in PMC

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