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Labor induction and cesarean delivery: A prospective cohort study of first births in Pennsylvania, USA
Author(s) -
Kjerulff Kristen H.,
Attanasio Laura B.,
Edmonds Joyce K.,
Kozhimannil Katy B.,
Repke John T.
Publication year - 2017
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12286
Subject(s) - medicine , obstetrics , labor induction , childbirth , vaginal delivery , prospective cohort study , pregnancy , cohort study , cesarean delivery , uterine rupture , confounding , logistic regression , gynecology , oxytocin , uterus , surgery , pathology , biology , genetics
Background Mode of delivery at first childbirth largely determines mode of delivery at subsequent births, so it is particularly important to understand risk factors for cesarean delivery at first childbirth. In this study, we investigated risk factors for cesarean delivery among nulliparous women, with focus on the association between labor induction and cesarean delivery. Methods A prospective cohort study of 2851 nulliparous women with singleton pregnancies who attempted vaginal delivery at hospitals in Pennsylvania, 2009‐2011, was conducted. We used nested logistic regression models and multiple mediational analyses to investigate the role of three groups of variables in explaining the association between labor induction and unplanned cesarean delivery—the confounders of maternal characteristics and indications for induction, and the mediating (intrapartum) factors—including cervical dilatation, labor augmentation, epidural analgesia, dysfunctional labor, dystocia, fetal intolerance of labor, and maternal request of cesarean during labor. Results More than a third of the women were induced (34.3%) and 24.8% underwent cesarean delivery. Induced women were more likely to deliver by cesarean (35.9%) than women in spontaneous labor (18.9%), unadjusted OR 2.35 (95% CI 1.97‐2.79). The intrapartum factors significantly mediated the association between labor induction and cesarean delivery (explaining 76.7% of this association), particularly cervical dilatation <3 cm at hospital admission, fetal intolerance of labor, and dystocia. The indications for labor induction only explained 6.2%. Conclusions Increased risk of cesarean delivery after labor induction among nulliparous women is attributable mainly to lower cervical dilatation at hospital admission and higher rates of labor complications.