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Grand Rounds

Is There a Link between Induction of Labor and Cesarean Delivery?

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BACKGROUND AND PURPOSE:

  • There is some concern that the increasing trend in induction of labor (IOL) may increase the overall rate of cesarean in the population
  • Kruit et al. (BMJ Open, 2022) investigated the influence of increasing rates of IOL on the rate of caesarean delivery

METHODS:

  • Population-based retrospective study
  • Population
    • Pregnancies in Finland from 2008 to 2019
    • Data derived from The Finnish Medical Birth Register
  • Exposures
    • IOL
  • Study design
    • Medical Birth Register data are compiled at the time of birth | Based on mother’s prenatal charts, the Central Population Register (live births) and the Cause of Death Register (stillbirths and neonatal deaths)
    • Three study periods
      • 2008–2010: Period 1
      • 2011–2013: Period 2
      • 2014–2016: Period 3
      • 2017–2019: Period 4
  • Primary outcomes
    • Rates of IOL and caesarean delivery

RESULTS:

  • 663,024 live births during study period
  • The rate of labor induction increased during the study (P<0.001)
    • Period 1: 17.8%
    • Period 4: 30.3%
  • Total cesarean delivery rate: 16.5%
  • Overall cesarean delivery rate increased (p<0.001)
    • Period 1: 16.3%
    • Period 4: 17.0%
  • The rate of cesarean delivery following IOL slightly declined over the same period (P<0.001)
    • Period 1: 15.41%
    • Period 4: 15.35%
  • In multivariate logistic regression analysis, IOL was associated with a reduced risk for caesarean delivery
    • OR 0.72 (95% CI, 0.71 to 0.74)
  • During the study, the rates of the following increased in the population
    • Advanced maternal age (P<0.001)
      • Period 1: 18.0%
      • Period 4: 23.5%
    • Obesity (P<0.001)
      • Period 1: 11.4%
      • Period 4: 15.1%
    • Gestational diabetes
      • Period 1: 9.8%
      • Period 4: 23.3%

CONCLUSION:

  • Over a 12-year period, IOL in Finland has increased by 70%, but cesarean delivery rates have remained relatively stable
  • IOL increase likely due to higher maternal age at delivery and increasing obesity and GDM rates over the study period  
  • The authors state

The almost doubled rate of labour induction in Finland has not led to a significant increase in the rate of caesarean delivery

…after adjustment for birth year and background demographics, IOL was associated with a reduced risk for emergency caesarean delivery

Learn More – Primary Sources:

Breaking the myth: the association between the increasing incidence of labour induction and the rate of caesarean delivery in Finland – a nationwide Medical Birth Register study

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Related ObG Topics:

Does Elective Induction of Labor at 39 Weeks Gestation Lead to Improved Maternal and Newborn Outcomes?
Are Women with Obesity at Increased Risk for Failed Induction of Labor?
Low-Risk Multiparous Women: Induction of Labor at 39 Weeks or Expectant Management?

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