Open AccessElective induction of labor: failure to follow guidelines and risk of cesarean delivery
Author(s) -
LE RAY C.,
CARAYOL M.,
BRÉART G.,
GOFFINET F.
Publication year - 2007
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1080/00016340701245427
Subject(s) - medicine , induction of labor , labor induction , cervix , cesarean delivery , obstetrics , elective cesarean section , bishop score , risk factor , elective surgery , gynecology , pregnancy , anesthesia , oxytocin , genetics , cancer , biology
Background . Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery. Methods . We compared cesarean rates according to mode of onset of labor among 5,046 low‐risk patients. Violation of the guidelines was defined as induction before 38 weeks or with a Bishop score <5 or with prostaglandins. The cesarean risk was analysed with a bivariable and then a multivariable analysis, which used a multilevel logistic model. Results . Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR = 4.1, 95% CI [1.3–12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR = 3.2 [1.0–10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor. Conclusion . Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.