Maternal and neonatal outcomes by labor onset type and gestational age

Am J Obstet Gynecol. 2010 Mar;202(3):245.e1-245.e12. doi: 10.1016/j.ajog.2010.01.051.


Objective: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

Study design: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.

Results: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.

Conclusion: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction are associated with better neonatal outcomes compared to spontaneous labor. Elective induction may be associated with an increased hysterectomy risk.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Asphyxia Neonatorum / epidemiology
  • Cesarean Section*
  • Chorioamnionitis / epidemiology
  • Endometritis / epidemiology
  • Female
  • Gestational Age*
  • Humans
  • Hysterectomy / statistics & numerical data
  • Infant, Newborn
  • Intensive Care Units
  • Intensive Care Units, Neonatal
  • Labor, Induced*
  • Labor, Obstetric*
  • Length of Stay / statistics & numerical data
  • Outcome Assessment, Health Care*
  • Patient Admission / statistics & numerical data
  • Pregnancy
  • Respiration, Artificial / statistics & numerical data
  • Retrospective Studies
  • Sepsis / epidemiology
  • United States / epidemiology