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Retrospective study of maternal and neonatal outcomes after induction compared to spontaneous start of labour in women with one previous birth in uncomplicated pregnancies ≥ 41+3

Authors
  • Lindegren, Lina1, 2
  • Stuart, Andrea2
  • Carlsson Fagerberg, Marie3
  • Källén, Karin1
  • 1 University of Lund, BMC F12 , (Sweden)
  • 2 Helsingborg Hospital, Charlotte Yhlens gata 10 , (Sweden)
  • 3 Ystad Hospital, Kristianstadsvägen 3 , (Sweden)
Type
Published Article
Journal
Journal of Perinatal Medicine
Publisher
Walter de Gruyter GmbH
Publication Date
Aug 24, 2020
Volume
49
Issue
1
Pages
23–29
Identifiers
DOI: 10.1515/jpm-2020-0312
Source
De Gruyter
Keywords
License
Yellow

Abstract

ObjectivesTo study the association between induction and outcome among two-parous women in uncomplicated pregnancies ≥ 41+3, stratified by first labour delivery mode and conditions present at first delivery.MethodsThe Swedish Medical Birth Register was used to identify 58,964 uncomplicated singleton pregnancies among women with one previous birth between 1998 and 2014. Women with any registered pregnancy complications were excluded to minimise the risk for indication bias. The outcomes considered were emergency caesarean section (CS), and poor neonatal outcome (Apgar score <7 at 5 min, neonatal death, or meconium aspiration).ResultsWomen who were induced at their second labour had higher emergency CS rates compared to women in spontaneously started deliveries (adjusted risk ratio, ARR: 2.11; 95% CI: 2.00–2.23). Low Apgar score was more common after induction compared to spontaneously started labours (1.0 vs. 0.7%) (ARR: 1.44; 95% CI: 1.18–1.77). Increased CS rates were also found when comparing induction at 41 + 3 to 41 + 6 weeks to labour at 42 weeks or more, regardless of labour start (ARR 1.39; 95% CI: 1.26–1.52).ConclusionsWe found an increased risk of CS and poor neonatal outcome after second labour induction in prolonged pregnancies. The second labour vaginal success rate after induction was highly dependent, on first labour delivery mode, but also on diagnoses and conditions present at the first delivery.

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