Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37–42 in Norway during 1999–2019. (9th December 2022)

• Record Type: Journal Article
• Authors: Haavaldsen, Camilla; Morken, Nils‐Halvdan; Saugstad, Ola Didrik; Eskild, Anne
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 102:Number 2(2023)
• Page Start: 158
• Page End: 173
• Publication Date: 2022-12-09
• Subjects: induction of labor -- postpartum hemorrhage -- pregnancy -- stillbirth; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.14489
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: Introduction: Induction of labor is often performed to prevent adverse perinatal and maternal outcomes, and has become increasingly common. We studied whether changes in prevalence of labor induction in gestational weeks 37–42 weeks were accompanied by changes in adverse pregnancy outcomes or mode of delivery. Material and methods: We used data from the Medical Birth Registry of Norway, and included all singleton births in gestational weeks 37–42 in Norway, 1999–2019 ( n = 1 127 945). We calculated the prevalence of labor induction and outcome measures according to year of birth. We repeated these calculations for each gestational week at birth. Results: The prevalence of labor induction increased from 9.7% to 25.9%, and the increase was particularly high in gestational week 41. A modest decline in fetal deaths was observed in all gestational weeks, except gestational week 41. The overall decline was from 0.18% in 1999–2004 to 0.13% during 2015–2019. There were no overall changes in other perinatal outcomes. The prevalence of postpartum hemorrhage ≥500 ml increased from 11.4% in 1999 to 30.1% in 2019, and operative deliveries increased slightly. The prevalence of acute cesarean section increased from 6.5% to 9.3%, whereas vacuum and/or forceps assisted deliveries increased from 7.8% to 10.4%. Conclusions: A high increase in labor inductions was accompanied by a modest decline in fetal deaths, but no decline in other adverse perinatal outcomes. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs. Abstract : Despite a large increase in induction of labor, we found only a modest decrease in fetal deaths and no decrease in other adverse perinatal outcomes. The prevalence of excess postpartum hemorrhage increased dramatically. In settings where the prevalence of adverse perinatal outcomes is low, the beneficial effect of increased use of labor induction may not outweigh the side effects or the costs.