Five-year trends in induction of labour in a large Australian metropolitan maternity service.

Abstract

The World Health Organisation recommends that induction of labour (IOL) be performed only with a clear medical indication. Australian rates of IOL appear to be rising, with more than one-third of women having labour induced. This may reflect changing clinician and consumer perceptions of the benefits and potential harms of term IOL. To understand recent trends in the rates and indications for IOL. A retrospective cohort study was undertaken in a Level 6 maternity facility, in metropolitan South-East Queensland, Australia. Routinely collected data were gathered between 2015 and 2020. Exclusion criteria were multiple pregnancies, stillbirth and pre-labour rupture of membranes. Pre-labour rupture of membranes was excluded due to inability to assess if IOL for this indication was a true induction or augmentation of labour. Indications for induction were grouped into maternal, fetal, elective indications, 'post-dates' and decreased fetal movements (DFM). Rates of IOL and frequency of the various indications were compared over time. About 46530 livebirths occurred during the study period, with labour induced in 31.7%. The proportion of women undergoing IOL increased from 29.8% in 2015 to 33.4% in 2019 (P<0.001). The proportion of inductions for DFM and elective indications increased over time, with a substantial decrease in 'post-dates' IOL. This large contemporary analysis of IOL trends in Australia has demonstrated rising rates and changing indications for IOL. There remain large knowledge gaps in areas such as care of women with DFM, definitions and management of 'post-term pregnancy', and the economic and service impacts of rising trends in the rate of IOL.