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Early preterm preeclampsia outcomes by intended mode of delivery

American Journal of Obstetrics and Gynecology Oct 05, 2018

Coviello EM, et al. - Researchers investigated labor induction success rates and compared maternal and neonatal outcomes, by intended mode of delivery, in 914 singleton pregnant women with preeclampsia (identified from the Consortium on Safe Labor study) who delivered between 24 0/7 and 33 6/7 weeks. Findings revealed successful vaginal delivery in approximately one-half of women who attempted an induction. With gestational age, increasing rate of successful vaginal delivery was noted. Successful induction was found to prevent maternal and fetal comorbidities associated with previous cesarean deliveries in subsequent pregnancies. Although no differences were identified in terms of overall rates of a composite of serious maternal and neonatal morbidity/mortality between induction of labor and planned cesarean delivery groups, women with failed induction of labor displayed increased maternal morbidity.

Methods

  • Researchers performed a comparison of maternal and neonatal outcomes between women undergoing induction of labor (n=460) and planned cesarean delivery (n=454) and women with successful induction of labor (n=214) and unsuccessful induction of labor (n=246).
  • They used a Poisson regression model with propensity score adjustment to calculate relative risks (RRs) and 95% confidence intervals (CIs) in order to determine outcomes.
  • Propensity scores were calculated considering covariates such as maternal age, gestational age, parity, body mass index, tobacco use, diabetes mellitus, chronic hypertension, hospital type and site, birth weight, history of cesarean delivery, malpresentation/breech, simplified Bishop score, insurance, marital status, and steroid use.

Results

  • Among the 460 women with induction, 46% were vaginal deliveries.
  • By gestational age, 24 to 27 6/7, 28 to 31 6/7, and 32 to 33 6/7, the induction of labor success rates were 38% (12/32), 39% (70/180) and 54% (132/248), respectively.
  • Induction of labor was less frequently associated with placental abruption (aRR 0.33; 95% CI 0.16-0.67), wound infection or separation (aRR 0.23; 95% CI 0.06-0.85), and neonatal asphyxia (0.12; 95% CI 0.02-0.78) compared with planned cesarean delivery.
  • Women with vaginal delivery displayed decreased maternal morbidity (aRR 0.27; 95% CI 0.09-0.82) and were not different in neonatal outcomes vs those with failed induction of labor.
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