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  • Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study

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Obstetrics and gynaecology
Original research
Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study
  1. Hannah G Dahlen1,
  2. Charlene Thornton1,2,
  3. Soo Downe1,3,
  4. Ank de Jonge1,4,
  5. Anna Seijmonsbergen-Schermers4,
  6. Sally Tracy5,
  7. Mark Tracy6,
  8. Andrew Bisits7,
  9. Lilian Peters1,4,8
  1. 1 School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
  2. 2 College of Nursing and Health Sciences, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
  3. 3 Research in Childbirth and Health (ReaCH) Unit, University of Central Lancashire, Preston, Lancashire, UK
  4. 4 Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  5. 5 School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  6. 6 Westmead Newborn Intensive Care Unit, The University of Sydney Paediatrics and ChildHealth and WSLHD, Westmead, New South Wales, Australia
  7. 7 School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
  8. 8 Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Hannah G Dahlen; H.Dahlen{at}westernsydney.edu.au

Abstract

Objectives We compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births.

Design We used population linked data from New South Wales, Australia (2001–2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age.

Results Of 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years.

Conclusion IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.

  • obstetrics
  • maternal medicine
  • epidemiology
  • neonatology

Data availability statement

No data are available. We do not have ethics approval to share data.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-047040

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    Data availability statement

    No data are available. We do not have ethics approval to share data.

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    Footnotes

    • Twitter @hannahdahlen

    • Contributors HGD formulated the study and wrote the paper with LP, CT, SD and AdJ. LP analysed the data. CT and AS-S checked data and provided statistical advice. ST and MT provided advice on the manuscript and neonatal outcomes. AB provided obstetric advice.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.