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

Leslie Skeith (1, 2) , Grégoire Le Gal (1, 2) , Johanna de Vries (3) , Saskia Middeldorp (4) , Mariëtte Goddijn (4) , Risto Kaaja (5) , Jean-Christophe Gris (6, 7, 8) , Ida Martinelli (9) , Ekkehard Schleussner (10) , David Petroff (11) , Nicole Langlois (2) , Marc Rodger (2)

1 University of Calgary
2 OHRI - Ottawa Hospital Research Institute [Ottawa]
3 VU University Medical Center [Amsterdam]
4 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
5 University of Turku
6 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
7 EA 2992 - Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires
8 UM - Université de Montpellier
9 Fondazione IRCCS Istituto Nazionale Tumori - National Cancer Institute [Milan]
10 Jena University Hospital [Jena]
11 Leipzig University / Universität Leipzig

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.

Mots clés: Cesarean section; Induced labor; Low-molecular-weight heparin; Pre-eclampsia

Domaines: Gynécologie et obstétrique; Santé publique et épidémiologie

Leslie Skeith, Grégoire Le Gal, Johanna de Vries, Saskia Middeldorp, Mariëtte Goddijn, et al.. 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, 2019, 19, pp.455. ⟨10.1186/s12884-019-2615-x⟩. ⟨hal-02562010⟩