Elective Induction Compared With Expectant Management in Nulliparous Women With an Unfavorable Cervix

Abstract

To compare outcomes of labor between nulliparas with an unfavorable cervix who underwent either elective labor induction or expectant management beyond 39 weeks of gestation. We conducted a retrospective cohort study of nulliparous women with a singleton gestation who had an unfavorable cervix (modified Bishop score less than 5) and delivered between 2006 and 2008. One hundred two nulliparous women who underwent elective induction of labor between 39 and 40 5/7 weeks of gestation were compared with 102 nulliparous women who were expectantly managed beyond 39 weeks of gestation. The primary outcome, cesarean delivery, was not statistically different between women who were expectantly managed and those who underwent elective labor induction (34.3% compared with 43.1%, respectively, P=.16). Aside from the more frequent occurrence of meconium in the expectantly managed group (36.3% compared with 7.0%, P<.001), there were no significant differences in other maternal (eg, chorioamnionitis, operative vaginal delivery, third-degree and fourth-degree lacerations, postpartum hemorrhage) or neonatal (arterial cord pH less than 7.0, Apgar score less than 7 at 5 minutes, neonatal intensive care unit admission) outcomes. Women who underwent an elective induction of labor did have longer duration of labor and delivery between admission and delivery (median 16.5 compared with 12.7 hours, P<.001). For nulliparous women with an unfavorable cervix, elective labor induction increased utilization of labor and delivery resources but did not result in other significant differences in most clinical outcomes.