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Influence of Labor Induction on Operative and Spontaneous Deliveries: A Retrospective Cohort Study and Anesthesia Implications
Abstract Number: F4D-3
Abstract Type: Original Research
Background: Observational studies comparing women who underwent induction of labor with those who went spontaneous labor have not shown an increased risk of cesarean delivery. Operative deliveries such as forceps-assisted delivery (FAD) and vacuum-assisted deliveries (VAD) can significantly augment the successful rate of vaginal delivery in parturients. However, condition of birthing cannel and muscle strength could be affected by labor induction and neuraxial analgesia. We hypothesize that the outcome of FAD/VAD may be influenced by the labor induction.
Methods: A retrospective data analysis of all term, cephalic, singleton, nulliparous parturient who delivered at the Partner Healthcare System from June 1, 2015 to December 31, 2017 was conducted. Maternal and neonatal demographics, delivery indication intervention, characteristics and outcome data were recorded. Subgroup analysis was conducted in Induction + Forceps Delivery (Group IF), Spontaneous labor + Forceps Delivery (Group SF), Induction+ Vacuum Delivery (Group IV), Spontaneous labor + Vacuum Delivery (Group SV), Induction + Spontaneous Vaginal Delivery (Group ISV), Spontaneous labor + Spontaneous Vaginal Delivery (Group SSV) groups.
Results: Of 8207 nulliparous deliveries, the average cesarean delivery rate was 25.0%. The subgroup analysis demonstrated that the cesarean delivery rates were 3.3%, 4.5 %, 12.7%, 16.3%, 30.4% and 30.4% in the SF, IF, SV, IV, SSV and ISV group, respectively (P < 0.001) The general anesthesia rate was also lowest in Group SF (P < 0.001). However, forcepts deliveries are associated with more ≥3rd degree perineum lacerations (P < 0.001). Better neonatal 1-min Apgar scores (≥7) were shown Group SSV (P < 0.001), whereas Group SV had the best 5-min Apgar scores (≥7) (P < 0.05).
Discussion: Our data demonstrated that FAD lead to better success towards vaginal delivery. Labor induction did have a negative influence on the delivery mode. However, it also incurred more high-grade perineum lacerations. This implied the patient may need denser epidural coverage for delivery and laceration repair and potentially different postpartum pain control approach. Vacuum-assisted deliveries could provider quicker delivery then spontaneous vaginal delivery resulting in better neonatal Apgar scores.
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