(509) Elective Inductions of Labor at 39 weeks versus expectant management in multiparous patients

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

James D. Doss, MD (he/him/his)

Resident Physician
Washington University In St. Louis
St. Louis, Missouri, United States

Coauthor(s)

ER

Elise Requadt, BA

Clinical Research Assistant
Washington University at St. Louis
St. Louis, Missouri, United States
CN

Claire Novack, BS

Clinical Research Assistant
Washington University at St. Louis
St. Louis, Missouri, United States
AB

Anupama Balasubramanian, BA

Larner College of Medicine at the University of Vermont
Larner College of Medicine at the University of Vermont, Vermont, United States
CD

Carly Duncan, MD

Resident Physician
University of Alabama at Birmingham
Birmingham, Alabama, United States
DW

Dong Wang, PhD

Senior Statistical Data Analyst
Washington University at St. Louis, Department of Ob/Gyn
St. Louis, Missouri, United States
Antonina I. Frolova, MD, PhD (she/her/hers)

Assistant Professor of Ob&Gyn
Washington University School of Medicine
St. Louis, Missouri, United States
Jeannie C. Kelly, MD, MS (she/her/hers)

Associate Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
NR

Nandini Raghuraman, MD, MSCI

Assistant Professor of Ob&Gyn
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States

Objective: The ARRIVE trial demonstrated a reduction in cesarean section with similar perinatal outcomes in low risk nulliparas undergoing induction of labor (IOL) compared to expectant management (EM). We compared outcomes in low-risk multiparous patients undergoing IOL vs EM.

Study Design: We performed a retrospective cohort study of multiparous patients with low-risk singleton pregnancies at 39 weeks gestation from 2020-2022. All multiparous patients who delivered after 39 weeks were included, and patients undergoing IOL for medical or fetal indications were excluded. The primary outcome was composite neonatal morbidity. The secondary outcomes were cesarean section, postpartum hemorrhage (defined as estimated blood loss ≥1000 ml), and chorioamnionitis. These outcomes were compared between patients undergoing scheduled IOL between 39w0d and 39w6d and those undergoing expectant management at 39 weeks. Multivariable Firth’s penalized logistic regression was used to adjust for potential confounders.

Results: Of the 841 multiparous patients during the study period, 454 (54%) underwent IOL and 387 (46%) were EM. Among EM, 54 (14%) ultimately underwent an IOL. There were no significant differences in odds of having composite neonatal morbidity (aOR 1.04, 95% CI 0.63-1.71, p=0.88), cesarean delivery (aOR 2.09, 95% CI 0.9-4.79, p=0.09), or chorioamnionitis (aOR 0.58, 95% CI 0.13-2.57, p=0.48) in IOL group as compared to EM group. The odds of having postpartum hemorrhage were 2.6 times higher in IOL as compared to EM patients (aOR 2.59, 95% CI 1.24-5.42, p=0.011.)

Conclusion: Multiparous patients undergoing elective IOL have similar odds of cesarean section and neonatal morbidity as those undergoing EM. IOL is associated with an increased risk of hemorrhage compared to EM.