Maternal and neonatal outcomes by labor onset type and gestational age.

Publication Type
Journal Article
Year of Publication
2010
Authors
Bailit, Jennifer L; Gregory, Kimberly D; Reddy, Uma M; Gonzalez-Quintero, Victor H; Hibbard, Judith U; Ramirez, Mildred M; Branch, D Ware; Burkman, Ronald; Haberman, Shoshana; Hatjis, Christos G; Hoffman, Matthew K; Kominiarek, Michelle; Landy, Helain J; Learman, Lee A; Troendle, James; Van Veldhuisen, Paul; Wilkins, Isabelle; Sun, Liping; Zhang, Jun
Secondary
Am J Obstet Gynecol
Volume
202
Pagination
245.e1-245.e12
Date Published
2010 Mar
Keywords
Adult; Asphyxia Neonatorum; Cesarean Section; Chorioamnionitis; Endometritis; Female; Gestational Age; Humans; Hysterectomy; Infant, Newborn; Intensive Care Units; Intensive Care Units, Neonatal; Labor, Induced; Labor, Obstetric; Length of Stay; Outcome Assessment, Health Care; Patient Admission; Pregnancy; Respiration, Artificial; Retrospective Studies; Sepsis; United States
Abstract

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.