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  • Title: Elective induction of labor: failure to follow guidelines and risk of cesarean delivery.
    Author: Le Ray C, Carayol M, Bréart G, Goffinet F, PREMODA Study Group.
    Journal: Acta Obstet Gynecol Scand; 2007; 86(6):657-65. PubMed ID: 17520395.
    Abstract:
    BACKGROUND: Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery. METHODS: We compared cesarean rates according to mode of onset of labor among 5,046 low-risk patients. Violation of the guidelines was defined as induction before 38 weeks or with a Bishop score <5 or with prostaglandins. The cesarean risk was analysed with a bivariable and then a multivariable analysis, which used a multilevel logistic model. RESULTS: Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR=4.1, 95% CI [1.3-12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR=3.2 [1.0-10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor. CONCLUSION: Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.
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