Delivery outcomes after induction of labor among women with hypertensive disorders of pregnancy

Abstract

Objective

Induction of labor is known to be safe and highly effective in low-risk women. However, only limited research considers the relative success rates of induction of labor among women with one or more obstetric comorbidities. Our objective was to determine if the risk of cesarean delivery after induction of labor (IOL) is increased in women with a spectrum of hypertensive disorders of pregnancy compared to women with normotensive pregnancies.

Study design

We analyzed data from 1842 women undergoing IOL occurring at Grady Memorial Hospital in Atlanta, Georgia 2016–2018. We used multivariable log binomial models to estimate unadjusted and adjusted risk ratios (aRR) describing the association between hypertensive disorder diagnosis (preeclampsia with or without severe features, gestational hypertension, and chronic hypertension) and cesarean delivery, adjusting for demographics, pre-pregnancy conditions, and gestational age at delivery.

Results

Overall, 44% (n = 808) of women in our study were diagnosed with any hypertensive disorder. Among women with hypertensive disorders, 74% had a successful vaginal delivery after IOL as compared to 82% of women without a hypertensive disorder. In the fully adjusted model, women with preeclampsia with severe features (aRR: 1.6, 95% CI: (1.3, 2.0)) and chronic hypertension had the largest risk for cesarean delivery (aRR 1.3, 95% CI: 0.9, 1.7)) compared with women with a normotensive pregnancy.

Conclusion

Our study suggests that while patients with certain hypertensive diagnoses may be at increased risk for cesarean delivery following IOL, most patients with hypertensive disorders were still able to undergo a successful vaginal delivery following IOL.

Keywords:

• Hypertensive disorders of pregnancy
• induction of labor
• Cesarean delivery
• delivery complications
• preeclampsia

Disclosure statement

The authors report no conflicts of interest to report or sources of financial support for this study.