risk factor for cesarean delivery following labor induction.pptx

8/14/2019 Risk Factor For Cesarean Delivery Following Labor Induction.pptx

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Risk Factor For Cesarean

Delivery Following LaborInduction In Multiparous

Women

By: Nurmadiah, Novita AS, Putri P,

Ridwan B, Said TS, Yvonne FY.

Advisor:

Dr. Eddy Pangaribuan, Sp.OG (K)


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INTRODUCTION


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INTRODUCTION

A common and essential element ofcontemporary obstetric practice andnow accounts for approximately 20% ofall deliveries.

Thought to be associated with increasein the risk of cesarean delivery both fornulliparous and multiparous.

Induction of labor


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INTRODUCTION

Cesarean delivery:

The procedure carries theoperative risk in index

pregnancy and future pregnancy


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OBJECTIVES


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OBJECTIVE

To identifypotential riskfactors forcesarean deliveryfollowing labor

induction inmultiparouswomen at term.

Objective


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METHODS


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METHODS

We conducted a retrospectivecase-control study

Department of Obstetric andGynecology of the Maxima MedicalCentre, Veldhoven, The Netherlands,

1995-2010Included: multiparous, singlepregnancy, above 37 weeks

Excluded: fetal anomaly, noncephalicpresentation


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Controls

2 multiparous women withsuccessful induction of labor for

each case

Successful induction of labor

achieving vaginal deliveryanytime after the onset of

induction of labor


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Induction of labor

Patients with unfavorable cervix(Bishop score < 6)

Received 2 mg Prostin gel (1 mg forprelabor rupture of membranes) inposterior fornix of the vagina

Repeating th dose after 6 hours ifnecessary, depending on the Bishopscore


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Induction of labor

Amniotomy was performed inwomen with a favorable cervix

(Bishop score 6)

Oxytocin augmentation wasstarted with unsatisfactoryprogress of labor orcontractions were absent 60minutes after amniotomy


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Cases and controls

Maternal age

Height

Body mass index

Parity

Reason for induction

Gestational age

Bishop score

Need for epidural

Birth weight

Reason for cesarean delivery

Collected data:


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RESULTS


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RESULT

There was no significant difference in maternal age, parity, or reason forinduction of labor between cases and controls

Characteristics of the study population

Cesarean delivery was significantly associated with gestational age atdelivery, BMI, and matenal age

Gestational age at delivery, BMI, maternal age

Did not differ between cases and controls

Amount of effacement of cervix at the start of induction


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Associatedwith the riskof cesarean

delivery:

more dilated atstart of

induction

Nonengagementof the fetal head

Need for usingprostaglandins

as inductionmethod


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Previous obstetric history

Women with only previous preterm deliveryhad a significantly higher risk of cesareandelivery than those with at least oneprevious term delivery

Birth weight

No difference between the two groups

MULTIVARIATE ANALYSIS


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MULTIVARIATE ANALYSIS

The risk of cesarean delivery was

significantly associated with

low maternal height (OR 0.87,95%CI 0.80-0.95, P = 0.002)

A history of preterm delivery (OR5.3, 95% CI 1.1-25, P = 0.042)

Amount of dilatation at the startof induction of labor (OR 0.43,

95% CI 0.19-0.98, P=0.043)


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CESARIAN DELIVERY GROUP

10 women (13%) with presenting fetal head at the level of thepelvic inlet, so at station -3

50% of them, the method of induction was amniotomy, mostlyfollowed by oxytosin

Cesarean delivery group

Failure to progress because of negleted transverse lie (n=3) Prolapsed fetal arm (n=3)

Prolapsed umbilicard cord (n=1)

Non-engaged persistent occiput anterior position (n=1)

Fetal distress (n=2)

Indications for cesarean delivery:


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CONTROL GROUP

7 women (4%) the presenting fetal head at the

start of labor was at station -3

Only 29% of these seven women amniotomy was

performed, and they all delivered spontaneously


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DISCUSSION


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This study demonstrates that maternalheight, the amount of dilatation at thestart of induction and a history ofpreterm delivery played significant

roles in determining the risk ofcesarean delivery in inducedmultiparous women.

Induction of labor in multiparous womenresulted in a cesarean delivery rate of 3%


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In this study, in which we only includedwomen with at least one previous vaginal

birth

We considered the need for a cesarean after inductionof labor in a multiparous woman as the outcome

measure failure of induction of labor. Although awoman might have reached active labor, we were notinterested in another definition of failed induction,such as not reaching vaginal delivery within 24 hours.


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Women with a previous preterm delivery had

a higher risk of cesarean delivery afterinduced labor than those withat least oneprevious term delivery.

Our results are in line with the results of Park,indicating that the course of induction inwomen with a history of preterm deliverydiffers from women with a term delivery.

Preterm delivery


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In 13% (10/80) of the cases, the fetal head at thestart of induction was at station -3, whereas in

the control group this was only 4% (7/160).Taking the reasons for cesarean delivery in thesecases into account, one may conclude that oneshould be careful performing amniotomy if thefetal head is not properly engaged.


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Although we are aware of the additional risks

inducing women with a history of cesareandelivery, we included in both cases andcontrols six women with a previous cesareandelivery, besides a previous vaginal delivery. A

history of previous cesarean delivery was, inour study, not significantly associated with theoccurrence of cesarean delivery after inductionof labor.


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The 3% rate of cesarean delivery in

multiparous women in whom labor wasinduced should be compared with thecesarean delivery rate in multiparouswomen with spontaneous labor. Heffnerreports a cesarean delivery rate of 2.4%among multiparous women withspontaneous labor.


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The study of Jacquemyn et al. reported acesarean delivery rate of 1.5% in womenwith spontaneous onset of labor, ascompared to 2.8% in women withinduced labor . In the study of Nicholson

the cesarean delivery rate was 9.9%


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In multiparous women, the risk ofcesarean delivery following labor

induction increases with previouspreterm delivery, short maternalheight, and limited dilatation at thestart of induction.


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THANK YOU

risk factor for cesarean delivery following labor induction.pptx

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