Maternal and neonatal outcomes by labor onset type and gestational age

Presented orally at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010.

Received 20 November 2009; received in revised form 7 January 2010; accepted 19 January 2010.

Refers to article:

Latest research from the 2010 meeting of the Society for Maternal-Fetal Medicine
Jay D. Iams
American Journal of Obstetrics & Gynecology
March 2010 (Vol. 202, Issue 3, Page 207)
Full Text | Full-Text PDF (81 KB)

Elective delivery before 39 weeks: reason for caution
George A. Macones
American Journal of Obstetrics & Gynecology
March 2010 (Vol. 202, Issue 3, Page 208)
Full Text | Full-Text PDF (94 KB)

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.

Key words: elective delivery, hysterectomy, maternal outcomes, neonatal outcomes

a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

b Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA

c Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD

d University of Miami School of Medicine, Miami, FL

e Department of Obstetrics and Gynecology, University of Illinois at Chicago School of Medicine, Chicago, IL

f Department of Obstetrics and Gynecology, University of Texas Medical School at Houston, Houston, TX

g Intermountain HealthCare, Salt Lake City, UT

h Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, MA

i Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY

j Summa Health System, Akron, OH

k Christiana Care Health System, Wilmington, DE

l Indiana University–Clarian Health, Indianapolis, IN

m MedStar Health, Washington, DC

n Emmes Corporation, Rockville, MD

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Reprints not available from the authors.

This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, through a contract (Contract no. HHSN267200603425C).

Cite this article as: Bailit JL, Gregory KD, Reddy UM, et al. Maternal and neonatal outcomes by labor onset type and gestational age. Am J Obstet Gynecol 2010;202:245.e1-12.

PII: S0002-9378(10)00081-5

doi:10.1016/j.ajog.2010.01.051

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