Does Induction of Labor Increase the Risk for Cesarean Section?
Notice bibliographique
Résumé
Rising rates of cesarean delivery are a major concern for all medical professionals. Reducing the frequency of induction is often mentioned as a means to reverse this trend. Published studies and review articles have examined induction of labor (IOL) versus expectant management and the risk for cesarean delivery, with conflicting results. This systematic review and meta-analysis was performed to determine whether IOL compared with expectant management in women with intact membranes increased the rate of cesarean delivery. MEDLINE, EMBASE, and the Cochrane Database of Clinical Trials were searched. Studies were included if IOL, for indications other than premature rupture of membranes, was compared with expectant management and outcome data on route of delivery were provided. Quantitative analyses with fixed- and random-effects models were performed. Of 1368 unique citations, the review included 37 studies; 27 were induction trials of uncomplicated pregnancies at 37 to 42 weeks of gestation and 10 evaluated IOL versus expectant management in pregnancies with suspected macrosomia, gestational diabetes, oligohydramnios, twins, intrauterine growth restriction, and mild gestational hypertension as well as in women with a high risk score for cesarean delivery. The reported overall cesarean delivery rates varied from 1% to 47%. In almost all studies, IOL was necessary in many of the expectantly managed patients, with rates of 4% to 50%. Most trials reported that the time to delivery increased by approximately 1 week in the expectantly managed group versus the IOL group. Nineteen trials were evaluated to be of high quality; and 17, of low quality. A quantitative summary analysis combined results of 31 trials, with 6248 and 5917 women randomized to IOL and expectant management, respectively. Induction of labor was associated with a reduction in the risk for cesarean delivery compared with expectant management (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.76–0.92). The reduced risk for cesarean delivery was seen in both subgroups of the trials, specifically those examining IOL in women with late-term and postterm gestations (OR, 0.85; 95% CI, 0.76–0.95), and in the trials of IOL for other indications (OR, 0.81; 95% CI, 0.69–0.95). Subgroup analysis of only the 19 high-quality trials revealed a similar result (OR, 0.82; 95% CI, 0.73–0.91). Meta-analysis of the risk for cesarean delivery for fetal distress or the outcomes of postpartum hemorrhage and operative vaginal delivery did not find an increase with IOL. In addition, no statistically significant differences were seen between IOL and expectant management for Apgar score of less than 7 at 5 minutes, admission to the neonatal intensive care unit, or perinatal death. Induction of labor is associated with a moderate but statistically significant reduction in the risk for cesarean delivery. Differences in other maternal and neonatal outcomes were not apparent. On the basis of these findings, it may be that women at high risk for cesarean delivery (older age or obese) could benefit from elective induction. This should be investigated in further clinical trials.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,016 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».