Does an elective induction policy negatively impact on vaginal delivery rates? A 30-month review of an elective induction policy.

BACKGROUND: The rate of induction of labour varies across Health Service Executive hospital regions in Ireland averaging at 23.3 per 100 deliveries in 2005-2009. The increasing rate of elective induction of labour in Ireland calls for more studies looking into associated maternal and/or neonatal outcomes.

STUDY AIM: The aim of this study is to show that an elective induction policy with management by a sole consultant obstetrician can decrease caesarean section rates as well as positively impact maternal and neonatal complications.

METHODS: We conducted a retrospective review of women attending a named obstetrician over a 1-year period. In total, 22 variables were collected, including basic patient demographics, mode of onset of labour, method of induction, mode of delivery, length of labour and neonatal outcomes.

RESULTS: In total, 583 patients were identified in the study period. One hundred twenty-six (21.6%) patients presented with a spontaneous onset of labour, and 405 (69.4%) of patients had an induction of labour. Relative risk of having an emergency caesarean section, if labour is induced, is 1.42 (95% CI 0.64 to 3.14), and no statistical significance was demonstrated (p = 0.38). There was a statistically significant difference in operative vaginal delivery versus standard vaginal delivery relative risk between women ≥ 35-year-old and < 35-year-old groups, 0.47 (95% CI 0.39-0.57), p < 0.0001.

CONCLUSION: Elective induction of labour is not associated with an increased risk of caesarean section or operative vaginal delivery in patients less than 35 years of age. This shows that elective induction is an appropriate intervention in selected scenarios without affecting mode of delivery.