(1077) Outcomes of induced labor by delivery mode in a large diverse integrated health care system

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: To compare patient characteristics and outcomes associated with vaginal delivery (VD) versus unplanned cesarean delivery (CD) during induced labor (IOL) in a large diverse integrated health care delivery system.

Study Design: Retrospective cohort study of all term pregnancies within Kaiser Permanente Northern California (KPNC) 2011-2021. Among patients delivered at ≥37w0d with complete data available in the Perinatal Research Unit Obstetric Database, after excluding those with planned cesarean deliveries (CD), IOL was determined by the use of cervical ripening agents (mechanical or pharmacologic) and/or use of oxytocin in relation to the onset of labor determined by contraction and cervical dilatation data. We excluded patients with augmented labors (oxytocin after labor onset) or if augmentation/induction could not be differentiated from retrospective data. Maternal baseline and obstetric characteristics, and maternal and neonatal outcomes were compared among those with VD and those with CD after IOL using multivariable logistic regression models adjusted for age, BMI, race/ethnicity, parity, Neighborhood Deprivation Index, insurance type, diabetes, gestational diabetes, pre-existing hypertension, and hypertensive disorders of pregnancy.

Results: Among 95,561 induced labors, 74,317 (77.8%) had VD and 21,244 (22%) had CD. Rate of CD decreased slightly over time, from 23.4% in 2011 to 21.9% in 2021. Patients with VD were more likely to be younger, multiparous, non-obese, and White or Hispanic than those with CD, and less likely to have underlying chronic or acute conditions including diabetes or GDM and hypertension (Table 1). Compared with VD, CD was associated with higher rates of maternal ICU admission, postpartum hemorrhage, and chorioamnionitis (Table 2), in addition to higher rates of neonatal ICU admission and low Apgar score (Table 2).

Conclusion: In this large, diverse, contemporary cohort of term pregnancies, unplanned CD during IOL was independently associated with adverse maternal and neonatal outcomes compared with IOL resulting in VD.

Primary & Presenting Author(s)

Mara Greenberg, MD (she/her/hers)
Clinical and Research Director, Regional Perinatal Service Center
Kaiser Permanente Northern California
Berkeley, California, United States

Coauthor(s)

FX
Fei Xu, MS
Kaiser Permanente Northern California Division of Research
Oakland, California, United States
SM
Sarah Mandel, MD
Kaiser Permanente Oakland Medical Center
Oakland, California, United States
JB
Jennifer M. Baker, MPH
Kaiser Permanente Northern California
Oakland, California, United States
MK
Michael Kuzniewicz, MD, MPH
Kaiser Permanente Northern California
Oakland, California, United States
Monique Hedderson, PhD
Senior Research Scientist
Kaiser Permanente Northern California
Oakland, California, United States