The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study

AFFIRM investigators, Leslie Skeith, Grégoire Le Gal, Johanna I.P. de Vries, Saskia Middeldorp, Mariëtte Goddijn, Risto Kaaja, Jean Christophe Gris, Ida Martinelli, Ekkehard Schleußner, David Petroff, Nicole Langlois, Marc A. Rodger

Research output: Contribution to journalArticle

Abstract

BACKGROUND: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). METHODS: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. RESULTS: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p = 0.01). CONCLUSIONS: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.

Original languageEnglish
Article number455
JournalBMC Pregnancy and Childbirth
Volume19
Issue number1
DOIs
Publication statusPublished - Nov 29 2019

Keywords

  • Cesarean section
  • Induced labor
  • Low-molecular-weight heparin
  • Pre-eclampsia

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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  • Cite this

    AFFIRM investigators, Skeith, L., Le Gal, G., de Vries, J. I. P., Middeldorp, S., Goddijn, M., Kaaja, R., Gris, J. C., Martinelli, I., Schleußner, E., Petroff, D., Langlois, N., & Rodger, M. A. (2019). The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study. BMC Pregnancy and Childbirth, 19(1), [455]. https://doi.org/10.1186/s12884-019-2615-x