Baby by Appointment? NURS 350~ Ferris State University Amanda Badgley Christine Demler Mariah Lab Tracie Strand Denise VanderWeele F erris State University, NURS 350

Spontaneous Onset of Labor VS. Elective Induction of Labor Spontaneous Onset of Labor starts naturally usually occurs between weeks gestation Elective IOL no medical reason 1/3 of all deliveries

Expectant Management of Labor C/section Trends 53% Incr. between % Of all deliveries in 2010 OB nurse observations (Menacker, & Hamilton, 2010).

PICO Statement P (Population) normal pregnant women at > 38 weeks gestation I (Intervention) having an elective IOL C (Comparison) waiting for the spontaneous onset of labor O (Outcome) have a higher c/s rate as a result of a “failed” induction

Literature Search High level of evidence Peer reviewed Recent research Reliable publications

Article #1 Overview Elective IOLs full term pregnancies (37-41 weeks) frequency of emergency c/section using different induction methods. Conclusion: Elective IOLs = 2x chance of emergency c/section Cervical ripening = 3x chance of emergency c/section (Jonsson, Cnattingius, & Wikström, 2012)

Article #1 Evidence 13,980 births 7973 met criteria 7630 women had spontaneous labor 343 had elective IOL Prolonged labor: stress on baby non-reassuring fetal emergency c/section (Jonsson et al., 2012).

Article #1 Conclusions The information in this article can help doctors and patients make a more informed choice on whether or not to induce labor especially if there is no medical need to induce.

Article #2 Overview 13 hospitals in Finger Lakes, NY. 14,500 deliveries per year. New York State birth-certificate database from ,000 women low-risk singleton vertex presentation labored and delivered between 37 0/7 and 42 6/7 weeks (Glantz, 2010).

Article #2 Evidence Spontaneously laboring women (n=10, 608) Elective induction (n=1,241) were determined to have an increase chance of intrapartum interventions and adverse maternal outcomes. higher rates of NICU admissions maternal length of stay increased by 0.34 days (Glantz, 2010).

Article #2 Conclusions risk for cesarean deliveries by 1-2 deliveries per 25 elective IOLs v. spontaneous labor or expectant management. One million inductions in U.S.per year could mean as many as 40,000 cesarean deliveries could be potentially avoided (Glantz, 2010).

Article #3 Overview Birth between Chosen by a data base after the computer filtered through the women who met the inclusion criteria. Divided into either the control group or the test group (Osmundson, Ou-Yang, and Grobman, 2010).

Article #3 Evidence Test Group & Control Group 294 women in each group Nulliparity (first pregnancy), Gestational age >39 0/7 weeks A singleton vertex presentation Known cervical status at 38 0/7–38 6/7 weeks of gestation, A modified Bishop Score of at least 5 (Osmundson et al., 2010).

Article #3 Evidence (cont) All data are mean +/- s tandard deviation or %. (Osmundson et al., 2010, p. 603)

Article #3 Conclusion Peer reviewed and has been approved by Northwestern University (Osmundson et al., 2010). Without bias Research information 1975 to present Different results with larger sample size?

Article #4 Stanford -SCSF Evidence-Based Practice Center Maternal risk in elective IOL vs. Expectant management & Spontaneous onset of Labor 3,722 published articles reviewed 76 met criteria (Caughey et al., 2009). further classified by gestational age

Article #4 Evidence “The overall cesarean delivery rate among the women who were induced and those who were expectantly managed was 11 percent and 14 percent, respectively,” (Caughey et al., 2009) 20% reduction in c/sect rate for women induced at > 41 0/7 wks. gestation. < 41 weeks - no difference in C/sect rate (Caughey et al., 2009)

Article #4 Evidence “These findings are consistent with other meta-analysis of induction of labor in post term and term pregnancies but are contrary to many observational studies.” (Caughey et al., 2009).

Article #4 Conclusions 9 RCTs =20 % c/s rate for elective IOLs at > 41 wks. gest. v. expectant management of labor Observational studies = C/s rate for patients who choose elective IOL No difference in c/s rate for those elective IOLs < 41 wks. gest

Analysis & Application Elective induction? C/section? Gestational age? Expectant Management? Bishop score? Favorable Cervix? Spontaneous Labor?

Reference Caughey, A., Sundaram, V., Kaimal, A., Cheng, Y., Gienger, A., Little, S., Lee, J., & Wong, L. (2009). Maternal and neonatal outcomes of elective induction of labor. 176(1), Retrieved from / Glantz, J. (2010). Term labor induction compared with expectant management. Obstetrics & Gynecology,115(1), doi: /AOG.0b013e3181c4ef96

Reference Jonsson, M., Cnattingius, S., & Wikström, A. (2012). Elective induction of labor and the risk of cesarean section in low-risk parous women: a cohort study. Acta Obstet Gynecol Scand, 92(2), doi: /aogs Menacker, F. & Hamilton, B. (2010). Recent trends in cesarean delivery in the United States. NCHS Data Brief 35. Retrieved from:

Reference Osmundson, S., Ou-Yang, R., & Grobman, W. (2010). Elective induction compared with expectant management in nulliparous women with a favorable cervix. Obstetrics & Gynecology, 116(3), doi: /AOG.0b013e3181eb6e9b