Does Labor Induction In Nulliparous, Term, Singleton And Vertex Pregnancies Increase The Risk Of Cesarean Delivery?

INTRODUCTION: Efforts have been made to reduce the rate of cesarean delivery in nulliparous, term, singleton, vertex (NTSV) pregnancies. We set out to evaluate whether labor induction in this patient population is associated with an increased risk of cesarean delivery. METHODS: A meta-analysis was performed analyzing fourteen randomized controlled trials that met inclusion criteria. These included all randomized controlled trials of NTSV patients with intact or ruptured membranes that were randomized to induction of labor or control (i.e. expectant management). The primary outcome was the incidence of cesarean delivery. Secondary outcomes included incidence of cesarean delivery after induction of labor in ruptured versus intact membranes, as well as incidence of NICU admission. Results were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS: A total of 2,706 patients were analyzed. NTSV gestations undergoing induction of labor had a similar incidence of cesarean delivery compared to controls (24.6% versus 24.6%; OR 1.095; 95% CI 0.89–1.34). Rates of cesarean delivery in patients with intact membranes (28.7% versus 30.2%; OR 1.041; 95% CI 0.81–1.32) and ruptured membranes (15.1% versus 11.9%; OR 1.321; 95% CI 0.88–1.98) undergoing induction were also similar. Likewise, the incidence of NICU admission associated with labor induction was not statistically different compared to control group (6.3% versus 6.9%; OR 0.928; 95% CI 0.59–1.46). CONCLUSION: Hospitals are incentivized to reduce the rate of cesarean sections in NTSV pregnancies. Patients, practitioners and hospitals can be assured that labor induction in this population does not increase the risk of cesarean delivery or NICU admission.