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Health Resource Utilization of Labor Induction versus Expectant Management

Citation

Grobman, William A.; Sandoval, Grecio; Reddy, Uma M.; Tita, Alan T. N.; Silver, Robert M.; Mallett, Gail; Hill, Kim; Rice, Madeline Murguia; El-Sayed, Yasser Y.; & Wapner, Ronald J., et al. (2020). Health Resource Utilization of Labor Induction versus Expectant Management. American Journal of Obstetrics & Gynecology, 222(4), 369.e1-11. PMCID: PMC7141954

Abstract

BACKGROUND: Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization.
OBJECTIVE: The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum.
STUDY DESIGN: This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum.
RESULTS: Of 6096 women with data available, those in the induction of labor group (n = 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P = .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all).
CONCLUSION: Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.

URL

http://dx.doi.org/10.1016/j.ajog.2020.01.002

Reference Type

Journal Article

Article Type

Regular

Year Published

2020

Journal Title

American Journal of Obstetrics & Gynecology

Author(s)

Grobman, William A.
Sandoval, Grecio
Reddy, Uma M.
Tita, Alan T. N.
Silver, Robert M.
Mallett, Gail
Hill, Kim
Rice, Madeline Murguia
El-Sayed, Yasser Y.
Wapner, Ronald J.
Rouse, Dwight J.
Saade, George R.
Thorp, John M., Jr.
Chauhan, Suneet P.
Iams, Jay D.
Chien, Edward K.
Casey, Brian M.
Gibbs, Ronald S.
Srinivas, Sindhu K.
Swamy, Geeta K.
Simhan, Hyagriv N.
Macones, George A., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

PMCID

PMC7141954

Continent/Country

United States of America

State

Nonspecific