Saturday, December 5, 2009

Women With Long First Stage of Labor After Induction Are At Greater Risk For Cesarean

According to Reuters Health, in a report on Nov 27, 2009, pregnant women who spend a longer time in the first stage of labor after induction are more likely to require cesarean delivery and are also at greater risk of morbidity, new research shows.

To investigate, the researchers reviewed records for 3620 singleton, term pregnancies induced and delivered during the second stage. The duration of the first stage was defined as the time between the onset of labor (not the initiation of labor induction) to complete cervical dilation.

For most women (64.2% of firt time mothers, and 82.6% of mothers who had previously given birth), the first stage of labor lasted less than 12 hours. Compared to these women, those whose first stage of labor was from 12 to 24 hours long were twice as likely to require cesarean sections, while the risk for women whose first stage of labor lasted 24 hours or longer was 7.44-times greater. Babies born to women with first stages longer than 24 hours were 2.03 times as likely to be admitted to the intensive care nursery.

Among first time moms,, 6.5% of whom had a first stage of labor 24 hours or longer, 43.5% delivered vaginally, 10.9% had operative (vacuum, forceps or episiotomy) vaginal deliveries, and 45.6% delivered by cesarean section.

The researchers conclude: "Although we do not recommend a specific time limit for labor induction, the question of when to intervene should involve a thorough evaluation of the ongoing risks of further expectant management versus the risks of surgical intervention as well as the incorporation of patient preferences into the decision-making process."
Am J Obstet Gynecol 2009;201:477.e1-7.

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