395: Outcomes of elective induction of labor at 40 weeks versus expectant management at community hospitals

Abstract

Recent evidence suggests that elective induction of labor may reduce cesarean deliveries and other obstetric outcomes. The current study compares elective induction of labor (eIOL) versus expectant management in nulliparous women at community hospitals. This is a retrospective cohort study of singleton, vertex, nonanomalous deliveries in community hospitals in California between 2007 and 2011 using linked hospital discharge and vital statistics data (n=544,537). We compared eIOL defined by the Joint Commission at 40 weeks with expectant management. The primary outcomes of interest were cesarean delivery, neonatal death, operative vaginal delivery, shoulder dystocia, 5 minute Apgars less than 7, NICU admission, neonatal respiratory distress syndrome (NRDS), chorioamnionitis, and endomyometritis. Rates were first compared using chi-square analysis and then examined using multivariate logistic regression controlling for maternal age, comorbidities, ethnicity, education level, initiation of prenatal care in the first trimester, and insurance status. Among women delivering at community hospitals, rates of cesarean delivery, neonatal death, operative vaginal delivery, and NICU admission were significantly lower among eIOL at 40 weeks than among women undergoing expectant management (Table 1). Rates of several adverse maternal and neonatal outcomes were also significantly lower among the eIOL group. Logistic regression analysis indicated expectant management past 40 weeks significantly increased the odds of cesarean delivery (OR 1.67, 95% CI 1.60-1.74) and neonatal death (OR 5.79, 95% CI 0.78-42.9) compared to eIOL. Among women delivering at community hospitals, risk of cesarean delivery, neonatal death, and several adverse maternal and neonatal outcomes are significantly higher among women undergoing expectant management than among woman undergoing eIOL at 40 weeks.