• Ole Bredahl Rasmussen and Steen Rasmussen.
• Department of Obstetrics and Gynecology, Hospital Unit Vest, Herning, Denmark. olebr@dadlnet.dk
• Acta Obstet Gynecol Scand. 2011 Aug 1; 90 (8): 857-62.

ObjectiveTo compare induction of labor and expectant management by gestational week with regard to the need for cesarean section (CS) in labor.DesignCohort study.SettingNational study based on the Danish Birth Registry.PopulationAggregated data from 230 528 deliveries from 2004 until mid-year 2009. Women with cesarean section before labor, previous cesarean, preterm birth, breech presentation, multiple pregnancy and specified medical illnesses in pregnancy were excluded.MethodsWe compared by gestational week nulliparous and parous women who were either induced or had expectant management until later spontaneous or induced labor. For each of five comparisons, we conducted multivariable logistic regression analysis, controlling for body mass index, age, smoking in pregnancy and use of epidural analgesia during labor.Main Outcome MeasureRate of CS in labor.ResultsFrom gestational week 39 and thereafter, there was no difference with regard to CS rates in labor among nulliparous and parous women when comparing women with induced labor and those women who waited for a later labor, either induced or spontaneous. The odds ratios (with confidence intervals) for CS in labor in nulliparous women were 0.99 (0.84-1.17), 1.16 (1.04-1.30), 1.04 (0.94-1.15), 1.00 (0.92-1.10) and 0.97 (0.88-1.07) for weeks 37-41, respectively. For parous women the corresponding figures were 1.72 (1.35-2.20), 1.27 (1.04-1.55), 1.15 (0.95-1.39), 1.18 (0.99-1.40) and 1.07 (0.87-1.32), respectively.ConclusionsInduction of labor provides a sound tool when counseling a woman either going past term or presenting with a problem, even if it is not a severe medical illness.© 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

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