Abstract
Objective: To examine predictive characteristics for cesarean delivery (CD) in women undergoing labor induction with a Foley balloon (FB).
Methods: A secondary analysis of a randomized, double-blind, control trial examining labor induction with a transcervical 30 mL or 60 mL FB. One-hundred ninety-nine women with term, vertex, singleton pregnancies and Bishop score < 5 were randomized to receive a transcervical 30 mL or 60 mL FB. Mode of delivery, labor complications and neonatal outcomes were recorded. A multivariable model was performed to determine predictive characteristics for CD.
Results: Increasing maternal age (p = 0.04), nulliparity (p =0.002) and chorioamnionitis (p < 0.001) were significantly associated with an elevated risk for CD. Nulliparity was associated in an almost 4-fold increased CD risk (relative risk [RR]: 3.88; 95% confidence interval [CI]: 1.22–12.3). Women aged ≥ 40 years, had an almost 3-fold increased risk of CD as compared to women aged 20–29 (RR: 2.91; 95% CI: 1.36–6.19) years. Chorioamnionitis was associated with nearly a 2-fold increased risk for CD (RR: 1.87; 95% CI: 1.06–3.32). A gestational age of ≥ 41 weeks, prostaglandin use during induction and induction indication did not affect mode of delivery.
Conclusion: In patients undergoing labor induction with a FB, increasing maternal age, nulliparity and chorioamnionitis are associated with an elevated risk for CD.
Acknowledgements
Presented at the Society of Maternal Fetal Medicine Annual Meeting, San Francisco, CA. Friday, 10 February 2011. Abstract # 166.
Declaration of interest
Dr. Caughey was funded as a Robert Wood Johnson Physician Faculty Scholar (RWJF-61535). Ms. Paul and Drs. Delaney, Shaffer, Cheng, Vargas and Sparks have no declarations of interest.