Inducing labour reduces risk of caesarean delivery by 12%, finds analysis.

Abstract

The risk of a caesarean delivery was 12% lower in womenwhose labour was induced than in women who were managed with expectant management, a new analysis has found. Researchers led by Khalid Khan, professor of women’s health and epidemiology at Barts and the London School of Medicine in London, carried out their study because they said that there was confusion about the risks associated with induction despite recent studies that had shown that there were fewer caesarean deliveries with induced labour than without it. They conducted a systematic review and meta-analysis of 157 randomised controlled trials that met their inclusion criteria and involved 31 085 deliveries. The results were published inCMAJ, the journal of the Canadian Medical Association. The analysis found that the risk of caesarean delivery was 12% lower with labour induction than with expectant management (pooled relative risk (RR) 0.88 (95% confidence interval 0.84 to 0.93); I=0%). The effect was significant in term and post-term gestations but not in pre-term gestations. Further analysis of the data showed that initial cervical score, indication for induction, and method of induction did not alter the main result. The risk of caesarean delivery was lower in both high risk and low risk pregnancies, and induction also reduced the risk of fetal death (RR 0.50 (0.25 to 0.99); I=0%) admission to a neonatal intensive care unit (RR 0.86 (0.79 to 0.94)). Induction did not affect maternal death (RR 1.00 (0.10 to 9.57); I=0%). Four methods of induction were associated with a significant reduction in risk of caesarean delivery: prostaglandin E2 (RR 0.90 (0.84 to 0.96)), misoprostol (RR 0.62 (0.48 to 0.81)), alternative methods (such as acupuncture, breast stimulation, bath, and enema) (RR 0.66 (0.50 to 0.86)), and mixed method (RR 0.81 (0.70 to 0.95)). However, oxytocin and amniotomy did not show a decreased risk of caesarean delivery. The researchers reported that their analysis had several limitations, including the fact that half the studies were unclear about how they concealed the allocation of women, which could bias the findings. They also said that they did not account for all confounding factors, such as age andweight, and that because some studies dated back to 1975 practices that were no longer used may have influenced the findings. Khan said that the finding of a reduced risk of caesarean with induced labour “supports evidence from systematic reviews but is contrary to prevalent beliefs and information from consumer organisations, guidelines, and textbooks.” He added, “These findings show that induction is a way to increase the likelihood of a vaginal birth.”

DOI: 10.1136/bmj.g2960

Cite this paper

@article{Kmietowicz2014InducingLR, title={Inducing labour reduces risk of caesarean delivery by 12%, finds analysis.}, author={Zosia Kmietowicz}, journal={BMJ}, year={2014}, volume={348}, pages={g2960} }