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      Elective induction of labor: A prospective observational study

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          Abstract

          The aim of the present study was to assess indications for induction and describe the characteristics and delivery outcome in medical compared to non-medical/elective inductions. During a three-month period, 1663 term inductions were registered in 24 delivery units in Norway. Inclusion criteria were singleton pregnancies with cephalic presentation at gestational age 37 +0 and beyond. Indications, pre-induction Bishop scores, mode of delivery and adverse maternal and fetal outcomes were registered, and compared between the medically indicated and elective induction groups. Ten percent of the inductions were elective, and the four most common indications were maternal request (35%), a previous negative delivery experience or difficult obstetric history (19%), maternal fatigue/tiredness (17%) and anxiety (15%). Nearly half of these inductions were performed at 39 +0–40 +6 weeks. There were fewer nulliparous women in the elective compared to the medically indicated induction group, 16% vs. 52% (p<0.05). The cesarean section rate in the elective induction group was 14% and 17% in the medically indicated group (14% vs. 17%, OR = 0.8, 95% CI 0.5–1.3). We found that one in ten inductions in Norway is performed without a strict medical indication and 86% of these inductions resulted in vaginal delivery.

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          Births: Final Data for 2014.

          This report presents 2014 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Birth and fertility rates are presented by age, live-birth order, race and Hispanic origin, and marital status. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.
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            Outcomes of elective induction of labour compared with expectant management: population based study

            Objective To determine neonatal outcomes (perinatal mortality and special care unit admission) and maternal outcomes (mode of delivery, delivery complications) of elective induction of labour compared with expectant management. Design Retrospective cohort study using an unselected population database. Setting Consultant and midwife led obstetric units in Scotland 1981-2007. Participants 1 271 549 women with singleton pregnancies of 37 weeks or more gestation. Interventions Outcomes of elective induction of labour (induction of labour with no recognised medical indication) at 37, 38, 39, 40, and 41 weeks’ gestation compared with those of expectant management (continuation of pregnancy to either spontaneous labour, induction of labour or caesarean section at a later gestation). Main outcome measures Extended perinatal mortality, mode of delivery, postpartum haemorrhage, obstetric anal sphincter injury, and admission to a neonatal or special care baby unit. Outcomes were adjusted for age at delivery, parity, year of birth, birth weight, deprivation category, and, where appropriate, mode of delivery. Results At each gestation between 37 and 41 completed weeks, elective induction of labour was associated with a decreased odds of perinatal mortality compared with expectant management (at 40 weeks’ gestation 0.08% (37/44 764) in the induction of labour group versus 0.18% (627/350 643) in the expectant management group; adjusted odds ratio 0.39, 99% confidence interval 0.24 to 0.63), without a reduction in the odds of spontaneous vertex delivery (at 40 weeks’ gestation 79.9% (35 775/44 778) in the induction of labour group versus 73.7% (258 665/350 791) in the expectant management group; adjusted odds ratio 1.26, 1.22 to 1.31). Admission to a neonatal unit was, however, increased in association with elective induction of labour at all gestations before 41 weeks (at 40 weeks’ gestation 8.0% (3605/44 778) in the induction of labour group compared with 7.3% (25 572/350 791) in the expectant management group; adjusted odds ratio 1.14, 1.09 to 1.20). Conclusion Although residual confounding may remain, our findings indicate that elective induction of labour at term gestation can reduce perinatal mortality in developed countries without increasing the risk of operative delivery.
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              Neonatal and maternal outcomes associated with elective term delivery.

              To quantify adverse neonatal and maternal outcomes associated with elective term delivery at less than 39 completed weeks of gestation. Prospective observational study conducted in 27 hospitals over the course of 3 months in 2007. Of 17,794 deliveries, 14,955 (84%) occurred at 37 weeks or greater. Of term deliveries, 6562 (44%) were planned, rather than spontaneous. Among the planned deliveries, 4645 (71%) were purely elective; 17.8% of infants delivered electively without medical indication at 37-38 weeks and 8% of those delivered electively at 38-39 weeks required admission to a newborn special care unit for an average of 4.5 days, compared with 4.6% of infants delivered at 39 weeks or beyond (P < .001). Cesarean delivery rate in women undergoing induction of labor was not influenced by gestational age but was highly influenced by initial cervical dilatation and parity, ranging from 0% for parous women induced at 5 cm or greater to 50% for nulliparous women at 0 cm. Elective delivery before 39 weeks' gestation is associated with significant neonatal morbidity. Initial cervical dilatation is highly correlated with cesarean delivery among women undergoing induction of labor in both nulliparous and parous women. Elective delivery before 39 completed weeks' gestation is inappropriate. Women contemplating elective induction at or beyond 39 weeks' gestation with an unfavorable cervix should be counseled regarding an increased rate of cesarean delivery.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 November 2018
                2018
                : 13
                : 11
                : e0208098
                Affiliations
                [1 ] Department of Obstetrics and Gynecology, St. Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway
                [2 ] Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
                [3 ] Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
                [4 ] Department of Obstetrics, Oslo University Hospital, Oslo, Norway
                [5 ] Department of Gynecology and Obstetrics, Innlandet Hospital Trust, Elverum, Norway
                [6 ] Department of Gynecology and Obstetrics, Stavanger University Hospital, Stavanger, Norway
                [7 ] Department of Gynecology and Obstetrics, Vestre Viken Hospital Trust, Drammen, Norway
                [8 ] Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway
                [9 ] Department of Obstetrics and Gynecology, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
                [10 ] Department of Gynecology and Obstetrics, Haugesund Hospital, Haugesund, Norway
                [11 ] Department of Gynecology and Obstetrics, Østfold Hospital Trust, Norway
                [12 ] Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
                Monash University, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0002-9241-0730
                http://orcid.org/0000-0003-2061-4336
                http://orcid.org/0000-0002-5225-0672
                Article
                PONE-D-18-18072
                10.1371/journal.pone.0208098
                6264859
                30496265
                611b8545-17fb-4558-90fe-4b9e3a16f7ad
                © 2018 Dögl et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 June 2018
                : 12 November 2018
                Page count
                Figures: 0, Tables: 3, Pages: 8
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Obstetric Procedures
                Cesarean Section
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Medicine and Health Sciences
                Women's Health
                Medicine and Health Sciences
                Health Care
                Health Statistics
                Morbidity
                People and Places
                Geographical Locations
                Europe
                Norway
                Social Sciences
                Sociology
                Education
                Educational Attainment
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                All relevant data are within the paper.

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