Comparing Induction of Labor With Expectant Management in Pregnancies With Congenital Anomalies [22L

Abstract

INTRODUCTION: Historically, induction of labor has been associated with higher rates of C-section, particularly when the starting cervical exam is unfavorable. However, recent studies have challenged this idea, showing lower rates of C-section for elective inductions in singleton cephalic pregnancies without anomalies at term compared to expectant management. This study aims to look at the rate of C-section in women with fetal anomalies who were induced at term as compared to those who were expectantly managed. METHODS: We conducted a retrospective review of pregnancies prenatally diagnosed with fetal anomalies delivered from 2012 to 2014 at a single referral center. Induction vs expectant management, gestational age, mode of delivery, maternal and fetal factors, and complications were evaluated. RESULTS: Of the 117 women included in the study, 64 were induced, while 53 were expectantly managed. 17.2% of the induced pregnancies were delivered via C-section, while 62.2% of the expectantly managed pregnancies were delivered via C-section. Further analysis including only patients delivered beyond 37 weeks, showed induction patients were 83% less likely to deliver via C-section compared to patients who were expectantly managed (95% CI [0.06, 0.48]). CONCLUSION: Our data suggests that patients with fetal anomalies, including patients with an “unfavorable cervix,” who are induced at term do not have higher rates of C-section as compared to those who are expectantly managed. This supports the conclusions of previous studies in regard to induction, but now can be expanded to pregnancies complicated by fetal anomalies.