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Maternal and neonatal outcomes by labor onset type and gestational age

Authors
Journal
American Journal of Obstetrics and Gynecology
0002-9378
Publisher
Elsevier
Publication Date
Volume
202
Issue
3
Identifiers
DOI: 10.1016/j.ajog.2010.01.051
Keywords
  • Elective Delivery
  • Hysterectomy
  • Maternal Outcomes
  • Neonatal Outcomes
Disciplines
  • Medicine

Abstract

Objective We sought to determine maternal and neonatal outcomes by labor onset type and gestational age. Study Design We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age. Results Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks ( P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28–0.53), sepsis (OR, 0.36; 95% CI, 0.26–0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48–0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08–9.54) with elective induction, 1.16 (95% CI, 0.24–5.58) with indicated induction, and 6.57 (95% CI, 1.78–24.30) with cesarean without labor compared to spontaneous labor. Conclusion Some neonatal outcomes improved until 39 weeks. Babies born with elective induction are associated with better neonatal outcomes compared to spontaneous labor. Elective induction may be associated with an increased hysterectomy risk.

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