Abstract
BackgroundTo determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction).MethodsThe AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor.ResultsThere were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35–1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17–0.84; p = 0.01).ConclusionsThe risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.
Highlights
To determine the risk of cesarean delivery after labor induction among patients with prior placentamediated pregnancy complications
Patients in the AFFIRM database were excluded from this sub-study if their current pregnancy ended in pregnancy loss, there was no labor data collected, there was no trial of labor because of an elective, unscheduled or emergent cesarean delivery (CD), or if an individual study principal investigator did not consent to data use for this study
Data analysis Demographic information according to induction of labor and spontaneous labor was reported, including participant age at trial enrollment, gravida, previous live births and pregnancy losses, body mass index (BMI), race, current or recent smoker having quit in the last year, previous venous thromboembolism (VTE: proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE)), and use of low-molecular-weight heparin (LMWH) prophylaxis during pregnancy
Summary
To determine the risk of cesarean delivery after labor induction among patients with prior placentamediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). Induction of labor occurs in one out of five pregnancies and may be due to maternal, fetal or elective indications [1, 2]. While induction of labor can reduce maternal and fetal risk in patients with pre-eclampsia or intrauterine growth restriction, it is unclear if induction of labor is associated with an increased rate of cesarean delivery (CD) in these patients, an intervention that carries its own risks [1, 2]. Previous randomized trials and meta-analyses evaluating patients undergoing induction of labor versus expectant management show no increased risk of CD, with the majority of trials including patients who were electively induced post-dates [1,2,3, 8, 9]. While there was no difference in the composite perinatal outcome, this trial has the potential to be practice changing because there was a significantly lower rate of CD and hypertensive disorders of pregnancy reported in the induction group [10, 11]
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