(725) Elective induction of labor versus expectant management after one prior cesarean delivery

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: Given the ARRIVE trial demonstrated the benefits of elective induction of labor (IOL) at 39 weeks in low-risk nulliparous patients, we sought to determine if elective IOL in low-risk patients with one prior cesarean delivery is associated with increased rates of vaginal deliveries without increased adverse outcomes.

Study Design: This repeated cross-sectional study used 2015-2020 US natality data from the National Center for Health Statistics. Low-risk patients with vertex presenting singleton pregnancies and one prior cesarean delivery were identified. Deliveries with induction of labor from 39w0d to 39w6d were compared to all deliveries occurring from 40w0d to 42w6d. Risks for adverse maternal and neonatal outcomes between the two groups were compared with adjusted logistic regression models accounting for demographic, clinical, and hospital characteristics with adjusted odds ratios (aORs) with 95% CIs. Trends of IOL were assessed using Joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs.

Results: From 2015-2020, 998,874 deliveries met inclusion criteria of which 23,880 (2.4%) underwent IOL from 39w0d to 39w6d (Table 1). The proportion of IOL at 39 weeks increased from 1.9% in 2015 to 3.5% in 2020 (AAPC 13.8%, 95% CI 7.3%, 20.7%). In adjusted analyses, TOLAC patients induced at 39 weeks were more likely to have a vaginal delivery when compared to those expectantly managed (aOR 1.31, 95% CI 1.27, 1.35). Among vaginal deliveries, IOL was associated with increased odds of an operative vaginal delivery (aOR 1.14, 95% CI 1.06, 1.23). IOL was not associated with increased odds of uterine rupture, peripartum hysterectomy, or ICU admission (Table 2). Analyzing neonatal outcomes, IOL was associated with increased odds of NICU admission (aOR 1.14, 95% CI 1.07, 1.22) but no difference in 5-minute APGAR scores < 5 or neonatal seizures.

Conclusion: When compared to expectant management, elective IOL at 39 weeks in low-risk patients with one prior cesarean delivery was associated with slightly increased odds of vaginal delivery with comparable maternal and neonatal outcomes.

Primary & Presenting Author(s)

Erinma P. Ukoha, MD, MPH (she/her/hers)
Clinical Fellow
Columbia University Medical Center
New York, New York, United States

Coauthor(s)

Uma M. Reddy, MD,MPH
Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States

Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief Willard C. Rappleye Professor and Chair
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States

Alexander M. Friedman, MD
Columbia University Irving Medical Center
New York, New York, United States

Timothy Wen, MD,MPH (he/him/his)
Clinical Fellow
University of California, San Francisco
San Francisco, California, United States