Maternal and neonatal outcomes by labor onset type and gestational age

• Published in: American journal of obstetrics and gynecology 2010-03, Vol.202 (3), p.245.e1-245.e12
• Main Authors: Bailit, Jennifer L., MD, MPH, Gregory, Kimberly D., MD, MPH, Reddy, Uma M., MD, MPH, Gonzalez-Quintero, Victor H., MD, MPH, Hibbard, Judith U., MD, Ramirez, Mildred M., MD, Branch, D. Ware, MD, Burkman, Ronald, MD, Haberman, Shoshana, MD, PhD, Hatjis, Christos G., MD, Hoffman, Matthew K., MD, MPH, Kominiarek, Michelle, MD, Landy, Helain J., MD, Learman, Lee A., MD, PhD, Troendle, James, PhD, Van Veldhuisen, Paul, PhD, Wilkins, Isabelle, MD, Sun, Liping, MD, MS, Zhang, Jun, PhD, MD
• Format: Article
• Language: English
• Subjects: Adult; Asphyxia Neonatorum - epidemiology; Biological and medical sciences; Cesarean Section; Chorioamnionitis - epidemiology; Delivery. Postpartum. Lactation; elective delivery; Endometritis - epidemiology; Female; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; hysterectomy; Hysterectomy - statistics & numerical data; Infant, Newborn; Intensive Care Units; Intensive Care Units, Neonatal; Labor, Induced; Labor, Obstetric; Length of Stay - statistics & numerical data; maternal outcomes; Medical sciences; neonatal outcomes; Obstetrics and Gynecology; Outcome Assessment, Health Care; Patient Admission - statistics & numerical data; Pregnancy; Respiration, Artificial - statistics & numerical data; Retrospective Studies; Sepsis - epidemiology; United States - epidemiology
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2010.01.051

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.