Labor Induction at 39 Weeks Versus Expectant Management in Women With Prior Cesarean Delivery [22P

Abstract

INTRODUCTION: To compare maternal and neonatal outcomes between elective induction (EIOL) and expectant management (EM) in low risk women with a prior cesarean delivery. METHODS: Records of women with a prior cesarean and whose plan of delivery was a trial of labor (TOLAC) were reviewed. Patients who reached 39 weeks and were low risk were included and divided into 2 groups. Those who were induced electively between 39 weeks 0 days and 39 weeks 6 days (EIOL) versus those who were not (EM). Low risk was defined as absence of a maternal or fetal indication for delivery prior to 41 weeks 6 days. The primary outcome was a composite of adverse neonatal outcomes. Secondary outcomes included repeat cesarean delivery (CD) and maternal morbidities. RESULTS: From July 2014–July 2019, 552 low risk women underwent TOLAC: 317 women in the EM and 235 in the EIOL group. The primary outcome occurred in 5.38% in the EM group and 3.40% in the EIOL group (OR 0.62, 95% CI 0.23–1.55). The frequency of CD was 31.86% in the EM group and 26.38% in the EIOL group (OR 0.766, 95% CI 0.52–1.13). CONCLUSION: Elective induction of labor at 39 weeks among low risk women with a history of prior cesarean section was not associated with an increase in perinatal morbidity, and was associated with lower rates of hysterotomy-associated complications and medically-indicated delivery. It is reasonable to offer elective induction of labor at 39 weeks to women who are candidate for TOLAC.