Cesarean Deliveries Drop 12% With Induction, Study Suggests

Diedtra Henderson

April 28, 2014

Inducing labor lowers the risk of cesarean delivery by 12% and also tamps down on the risk of the fetus dying or of the newborn infant being admitted to the neonatal intensive care unit, according to a meta-analysis.

Ekaterina Mishanina, MBBS, from Homerton Hospital University Trust, London, United Kingdom, and coauthors published the results of their systematic review and meta-analysis online April 28 in the Canadian Medical Association Journal.

Labor is induced in 1 of 5 births for varying medical reasons, according to Dr. Mishanina and colleagues. Cesarean delivery, which sometimes follows labor induction, carries risks including maternal death, infection, and postpartum depression for mother and respiratory distress syndrome for infants.

To determine the association between labor induction and cesarean delivery, the researchers searched 6 electronic databases, identifying 2894 potentially relevant studies. They winnowed that assortment down to 157 randomized controlled trials that compared labor induction with placebo or expectant management. The studies enrolled a total of 31,085 women.

The authors found that if a woman's cervix was unfavorable when induction began, her risk for cesarean delivery dropped by 13% with induction. However, for uncomplicated pregnancies, with no compelling medical reason to induce labor, the risk for cesarean delivery plummeted by 19%.

"Our meta-analysis showed that the risk of cesarean delivery following labour induction was significantly lower than the risk associated with expectant management. This finding supports evidence from systematic reviews but is contrary to prevalent beliefs and information from consumer organizations, guidelines and textbooks," Dr. Mishanina and coauthors write.

The findings echo an earlier retrospective cohort study indicating that electively inducing labor at 37 to 40 weeks of gestation significantly lowered the chances of cesarean delivery without upping the odds of severe lacerations, neonatal intensive care unit admission, or perinatal death.

Among the current study's limitations, the authors included studies dating back to 1975 and acknowledged that changing practices over time could have influenced their findings.

"Our meta-analysis has provided a robust answer to the disputed question of risk of cesarean delivery associated with induction of labour. Women whose labour was induced were less likely than those managed expectantly to have a cesarean delivery," the authors conclude.

The authors have disclosed no relevant financial relationships.

CMAJ. Published online April 28, 2014.

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