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Health resource utilization of labor induction versus expectant management.

Publication ,  Journal Article
Grobman, WA; Sandoval, G; Reddy, UM; Tita, ATN; Silver, RM; Mallett, G; Hill, K; Rice, MM; El-Sayed, YY; Wapner, RJ; Rouse, DJ; Saade, GR ...
Published in: Am J Obstet Gynecol
April 2020

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.

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Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

April 2020

Volume

222

Issue

4

Start / End Page

369.e1 / 369.e11

Location

United States

Related Subject Headings

  • Young Adult
  • Watchful Waiting
  • Ultrasonography, Prenatal
  • Prenatal Care
  • Pregnancy
  • Peripartum Period
  • Patient Readmission
  • Obstetrics & Reproductive Medicine
  • Length of Stay
  • Labor, Induced
 

Citation

APA
Chicago
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MLA
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Grobman, W. A., Sandoval, G., Reddy, U. M., Tita, A. T. N., Silver, R. M., Mallett, G., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network, . (2020). Health resource utilization of labor induction versus expectant management. Am J Obstet Gynecol, 222(4), 369.e1-369.e11. https://doi.org/10.1016/j.ajog.2020.01.002
Grobman, William A., Grecio Sandoval, Uma M. Reddy, Alan T. N. Tita, Robert M. Silver, Gail Mallett, Kim Hill, et al. “Health resource utilization of labor induction versus expectant management.Am J Obstet Gynecol 222, no. 4 (April 2020): 369.e1-369.e11. https://doi.org/10.1016/j.ajog.2020.01.002.
Grobman WA, Sandoval G, Reddy UM, Tita ATN, Silver RM, Mallett G, et al. Health resource utilization of labor induction versus expectant management. Am J Obstet Gynecol. 2020 Apr;222(4):369.e1-369.e11.
Grobman, William A., et al. “Health resource utilization of labor induction versus expectant management.Am J Obstet Gynecol, vol. 222, no. 4, Apr. 2020, pp. 369.e1-369.e11. Pubmed, doi:10.1016/j.ajog.2020.01.002.
Grobman WA, Sandoval G, Reddy UM, Tita ATN, Silver RM, Mallett G, Hill K, Rice MM, El-Sayed YY, Wapner RJ, Rouse DJ, Saade GR, Thorp JM, Chauhan SP, Iams JD, Chien EK, Casey BM, Gibbs RS, Srinivas SK, Swamy GK, Simhan HN, Macones GA, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Health resource utilization of labor induction versus expectant management. Am J Obstet Gynecol. 2020 Apr;222(4):369.e1-369.e11.
Journal cover image

Published In

Am J Obstet Gynecol

DOI

EISSN

1097-6868

Publication Date

April 2020

Volume

222

Issue

4

Start / End Page

369.e1 / 369.e11

Location

United States

Related Subject Headings

  • Young Adult
  • Watchful Waiting
  • Ultrasonography, Prenatal
  • Prenatal Care
  • Pregnancy
  • Peripartum Period
  • Patient Readmission
  • Obstetrics & Reproductive Medicine
  • Length of Stay
  • Labor, Induced