Maternal and Neonatal Outcomes of Induction of Labor Compared with Planned Cesarean Delivery in Women with Preeclampsia at 34 Weeks' Gestation or Longer

Am J Perinatol. 2018 Jan;35(1):95-102. doi: 10.1055/s-0037-1606185. Epub 2017 Aug 24.

Abstract

Objective: This study aims to compare outcomes of induction with planned cesarean in women with preeclampsia.

Study design: A retrospective cohort study, including women with singleton pregnancies, preeclampsia (mild, severe, and superimposed), and without previous cesarean at ≥ 34 weeks' gestation was conducted. Outcomes included primary outcome (intensive care unit [ICU] admission, thromboembolism, transfusion, and hysterectomy), composite severe neonatal outcome (asphyxia, arterial cord pH < 7.0, hypoxic-ischemic encephalopathy, and 5-minute Apgar score < 5), neonatal ICU (NICU) admission, transient tachypnea of newborn (TTN), and respiratory distress syndrome (RDS). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, controlling for confounders.

Results: Of 5,506 women with preeclampsia at ≥ 34 weeks' gestation, 5,104 (92.7%) women underwent induction. Induction compared with planned cesarean was not associated with an increased risk of the primary outcome but was related to increased risks of ICU admission (aOR: 3.29; 95% CI: 1.02-10.64), and linked to decreased risks of composite neonatal outcome (aOR: 0.32; 95% CI: 0.10-0.99), NICU admission (aOR: 0.60; 95% CI: 0.43-0.84), TTN (aOR: 0.38; 95% CI: 0.22-0.64), and RDS (aOR: 0.44; 95% CI: 0.22-0.86).

Conclusion: Induction was not associated with an increased risk of the primary outcome but was associated with an increased risk of ICU admission and decreased risks of neonatal outcomes.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Cesarean Section / statistics & numerical data*
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Labor, Induced / statistics & numerical data*
  • Logistic Models
  • Multivariate Analysis
  • Pre-Eclampsia / therapy*
  • Pregnancy
  • Pregnancy Outcome*
  • Respiratory Distress Syndrome, Newborn / epidemiology*
  • Retrospective Studies
  • United States
  • Young Adult