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To induce or not to induce labor: a macrosomic
dilemma - Gynecologic and Obstetric Investigation , vol 58, no 3,
2004, pp 121-125 Simhayoff N; Sheiner E; Levy A; et
al - (2004) |
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We assessed the effect of
labor induction among parturients carrying macrosomic fetuses on the risk
of a cesarean section (CS). The study population consisted of consecutive
women with singleton fetuses weighing >/=4,000 g, delivered between
1988 and 1999. A comparison was made between parturients who delivered
after labor induction and those who delivered without labor induction. The
Mantel-Haenszel procedure was used to obtain the weighted odds ratios
while controlling for confounding variables. During the study period,
4,755 women delivered macrosomic newborns in our institution. In 20% of
the women (n = 951) labor was induced, while 80% of them (n = 3,804)
delivered without labor induction. The women who delivered after labor
induction were more likely to be nulliparous (18.0 vs. 10.0%; p <
0.001). In addition, these women had significantly higher rates of
gestational diabetes (23.3 vs. 10.7%; p < 0.001), hypertensive
disorders (10.1 vs. 5.3%; p < 0.001), hydramnios (17.4 vs. 9.9%; p <
0.001), and oligohydramnios (2.1 vs. 0.2%; p < 0.001). The CS rate was
significantly higher among the patients who delivered after labor
induction as compared with those in whom labor was not induced (17.8 vs.
11.9%; odds ratio 1.6, 95% confidence interval 1.3-1.9, p < 0.001).
Stratified analysis using the Mantel-Haenszel technique was performed to
control for confounders such as gestational diabetes, hypertensive
disorders, previous CS, hydramnios, oligohydramnios, and nulliparity.
None of these variables changed the significant
association between induction of labor and CS. The induction of labor
among women carrying macrosomic fetuses was found to be an independent
risk factor for a CS.
(Author) |
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