The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study

Leslie Skeith, Grégoire le Gal, Johanna I. P. de Vries, Saskia Middeldorp, Mariëtte Goddijn, Risto Kaaja, Jean-Christophe Gris, Ida Martinelli, Ekkehard Schleußner, David Petroff, Nicole Langlois, Marc A. Rodger, AFFIRM investigators

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). METHODS: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. RESULTS: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p = 0.01). CONCLUSIONS: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.
Original languageEnglish
Pages (from-to)455
JournalBMC Pregnancy and Childbirth
Volume19
Issue number1
DOIs
Publication statusPublished - 29 Nov 2019

Cite this

Skeith, Leslie ; le Gal, Grégoire ; de Vries, Johanna I. P. ; Middeldorp, Saskia ; Goddijn, Mariëtte ; Kaaja, Risto ; Gris, Jean-Christophe ; Martinelli, Ida ; Schleußner, Ekkehard ; Petroff, David ; Langlois, Nicole ; Rodger, Marc A. ; AFFIRM investigators. / The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19, No. 1. pp. 455.
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title = "The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study",
abstract = "BACKGROUND: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). METHODS: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. RESULTS: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2{\%}) and spontaneous labor (79/364, 21.7{\%}) (odds ratio (OR) 0.60, 95{\%} CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8{\%}) compared to spontaneous labor (22.4{\%}) (OR 0.38, 95{\%} CI, 0.17-0.84; p = 0.01). CONCLUSIONS: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.",
author = "Leslie Skeith and {le Gal}, Gr{\'e}goire and {de Vries}, {Johanna I. P.} and Saskia Middeldorp and Mari{\"e}tte Goddijn and Risto Kaaja and Jean-Christophe Gris and Ida Martinelli and Ekkehard Schleu{\ss}ner and David Petroff and Nicole Langlois and Rodger, {Marc A.} and {AFFIRM investigators}",
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Skeith, L, le Gal, G, de Vries, JIP, Middeldorp, S, Goddijn, M, Kaaja, R, Gris, J-C, Martinelli, I, Schleußner, E, Petroff, D, Langlois, N, Rodger, MA & AFFIRM investigators 2019, 'The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study' BMC Pregnancy and Childbirth, vol. 19, no. 1, pp. 455. https://doi.org/10.1186/s12884-019-2615-x

The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study. / Skeith, Leslie; le Gal, Grégoire; de Vries, Johanna I. P.; Middeldorp, Saskia; Goddijn, Mariëtte; Kaaja, Risto; Gris, Jean-Christophe; Martinelli, Ida; Schleußner, Ekkehard; Petroff, David; Langlois, Nicole; Rodger, Marc A.; AFFIRM investigators.

In: BMC Pregnancy and Childbirth, Vol. 19, No. 1, 29.11.2019, p. 455.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - The risk of cesarean delivery after labor induction among women with prior pregnancy complications: a subgroup analysis of the AFFIRM study

AU - Skeith, Leslie

AU - le Gal, Grégoire

AU - de Vries, Johanna I. P.

AU - Middeldorp, Saskia

AU - Goddijn, Mariëtte

AU - Kaaja, Risto

AU - Gris, Jean-Christophe

AU - Martinelli, Ida

AU - Schleußner, Ekkehard

AU - Petroff, David

AU - Langlois, Nicole

AU - Rodger, Marc A.

AU - AFFIRM investigators

PY - 2019/11/29

Y1 - 2019/11/29

N2 - BACKGROUND: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). METHODS: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. RESULTS: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p = 0.01). CONCLUSIONS: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.

AB - BACKGROUND: To determine the risk of cesarean delivery after labor induction among patients with prior placenta-mediated pregnancy complications (pre-eclampsia, late pregnancy loss, placental abruption or intrauterine growth restriction). METHODS: The AFFIRM database includes patient level data from 9 randomized controlled trials that evaluated the role of LMWH versus no LMWH during pregnancy to prevent recurrent placenta-mediated pregnancy complications. The primary outcome of this sub-study was the proportion of women who had an unplanned cesarean delivery after induction of labor compared to after spontaneous labor. RESULTS: There were 512 patients from 7 randomized trials included in our sub-study. There was no difference in the risk of cesarean delivery between women with labor induction (21/148, 14.2%) and spontaneous labor (79/364, 21.7%) (odds ratio (OR) 0.60, 95% CI, 0.35-1.01; p = 0.052). Among 274 women who used LMWH prophylaxis during pregnancy, the risk of cesarean delivery was lower among those that underwent labor induction (9.8%) compared to spontaneous labor (22.4%) (OR 0.38, 95% CI, 0.17-0.84; p = 0.01). CONCLUSIONS: The risk of cesarean delivery is not increased after labor induction among a higher risk patient population with prior pregnancy complications. Our results suggest that women who receive LMWH during pregnancy might benefit from labor induction.

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