Evaluating Outcomes in Low-Risk Nulliparous Women who Underwent Labor Induction versus Expectant Management: Single Institution Experience

Abstract

Introduction: The ARRIVE study found that induction of labor decreased the rates for cesarean section and was not associated with adverse neonatal outcomes. However, it is unclear if their study results are generalizable. Here, we aimed to analyze the perinatal and maternal outcomes of women undergoing elective induction of labor versus expectant management at a single center tertiary hospital. Methods: We retrospectively investigated outcomes in 188 low risk nulliparous women who either underwent labor induction (n=66) or had spontaneous labor (n=122). Results: There were no statistically significant outcomes between the two groups as it relates to the mother and neonate. The rate of cesarean delivery was 20% in the induction group versus 16% in the active labor group (p = 0.713). The woman who underwent induction had a relatively higher risk for morbidity including third degree laceration (p = 0.329), hypertensive disorders of pregnancy (p = 0.246), chorioamnionitis (p = 0.828), hemorrhage (p = 0.586) and infection (p = 0.586). Women in the induction group also spent more time in the labor (p < 0.001). Neonates in the induction group did have a relatively higher risk for meconium aspiration syndrome (p = 0.246), requiring respiratory support within 72 hours (p = 0.398), hyperbilirubinemia requiring phototherapy (p = 1.00), and shoulder dystocia (p = 0.732). Conclusions: We provide evidence of higher rate of maternal and neonatal morbidity in women undergoing inductions, although not statistically significant. Thus, providers should have an informed discussion when deciding timing of delivery.