Maternal and Neonatal Outcomes By Labor Onset Type and Gestational Age

Authors

Jennifer L Bailit
Kimberly D Gregory
Uma M Reddy
Victor H Gonzalez-Quintero
Judith U Hibbard
Mildred M Ramirez
D Ware Branch
Ronald Burkman
Shoshana Haberman
Christos G Hatjis
Matthew K Hoffman
Michelle Kominiarek
Helain J Landy
Lee A Learman
James Troendle
Paul Van Veldhuisen
Isabelle Wilkins
Liping Sun
Jun Zhang

Publication Date

3-1-2010

Journal

American Journal of Obstetrics and Gynecology

Abstract

OBJECTIVE: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

STUDY DESIGN: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.

RESULTS: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.

CONCLUSION: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction are associated with better neonatal outcomes compared to spontaneous labor. Elective induction may be associated with an increased hysterectomy risk.

Keywords

Adult, Asphyxia Neonatorum, Cesarean Section, Chorioamnionitis, Endometritis, Female, Gestational Age, Humans, Hysterectomy, Infant, Newborn, Intensive Care Units, Intensive Care Units, Neonatal, Labor, Induced, Labor, Obstetric, Length of Stay, Outcome Assessment (Health Care), Patient Admission, Pregnancy, Respiration, Artificial, Retrospective Studies, Sepsis, United States

DOI

10.1016/j.ajog.2010.01.051

PMID

20207242

PMCID

PMC2888294

PubMedCentral® Posted Date

March 2011

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes