Comparison of Modified Labor Induction Strategies for Pregnant Women at a Single Tertiary Center Before and During the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic has substantially impacted healthcare systems and obstetric practices worldwide. Labor induction is a common procedure for preventing obstetric complications in high-risk populations. This study evaluated perinatal outcomes of labor induction using a modified management protocol in a tertiary care center during the COVID-19 pandemic.

Methods: We conducted a retrospective study by reviewing electronic structured delivery records of women who underwent elective labor induction between June 2020 and October 2022. We analyzed maternal characteristics, maternal outcomes, and neonatal outcomes during the pre-pandemic (June 2020 to May 2021) and pandemic periods (May 2021 to October 2022).

Results: The study included 976 cases: 325 pregnancies in the pre-pandemic group and 651 in the pandemic group. The pandemic group showed earlier gestational age at delivery (39 vs. 40 weeks, p < 0.01) and lower body mass index (27.1 vs. 27.5 kg/m², p = 0.03). During the pandemic period, we observed a significant increase in labor induction cases and a decrease in cesarean sections. Neonatal outcomes, including Apgar scores and intensive care admissions, showed no significant differences between groups. Subgroup analysis identified advanced maternal age (OR = 1.08; 95% CI = 1.03-1.14; p < 0.01) and primiparity (OR = 5.24; 95% CI = 2.75-9.99; p < 0.01) as independent risk factors for cesarean delivery.

Conclusions: Even under modified protocols for labor induction during the COVID-19 pandemic, more pregnancies underwent labor induction while achieving a significant reduction in cesarean sections. Advanced maternal age and primiparity were identified as independent risk factors associated with cesarean delivery.

Keywords: COVID-19 pandemic; cesarean section; fetal outcomes; labor induction; maternal outcomes.

Figure 1

Modified protocol for scheduled induction of labor. Labor induction was scheduled when patients met the following criteria: fetal biophysical profile score ≥ 8, unfavorable cervical effacement, and normal results for complete blood count, liver function tests, renal function tests, and coagulation profile. PCR, Polymerase Chain Reaction; ROM, rupture of membrane; DR, delivery room; ED, emergency department. * For appointments before 3 May 2022, the timeframe is set at 72 h, while for appointments after 4 May 2022, it is set at 48 h. These policies were based on guidelines from the Taiwan Centers for Disease Control.

Figure 2

Flow diagram for patient selection.