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    Induction success or failure: Does maternal age matter?

    Results of a new retrospective study show that among nulliparous women, older maternal age does not increase the risks for failing labor induction with a prostaglandin E2 vaginal insert or for cesarean delivery.1

    Conducted by researchers at the Rabin Medical Center, Petach-Tikva, Israel, the study included data from 537 nulliparous women with a Bishop score ≤7 at 34+0 to 41+6 gestational weeks who underwent labor induction using a 10 mg dinoprostone vaginal insert. Of the total population, 69 (12.8%) were “older,” defined as aged ≥35 years.

    Overall, the labor induction failure rate was 27.6%, and in a univariate analysis, it was not significantly different comparing the older women and the control group comprised of the 468 women aged <35 years (26.5% vs 34.8%; P=.502). The rate of cesarean delivery was significantly higher among the older women than in the controls (36.2% vs 21.4%; P=.009). However, in a regression analysis adjusting for potential confounders that included maternal body mass index, indication for delivery, birth weight, and gestational age at delivery, older age was not associated with an increased risk of either outcome. Short term neonatal morbidity was also not significantly different between the two study groups.

    “Based on our study, we believe that physicians should not be afraid to offer labor induction to women simply because they are of advanced maternal age. In considering the need for a priori cesarean section in these older nulliparous women, the decision should be individually tailored by taking into account other obstetrical and personal characteristics,” said Liran Hiersch, MD.

    Also see: Outpatient cerivcal ripening: Has its time come?

    Dr Hiersch is a physician in the Department of Obstetrics and Gynecology, Rabin Medical Center, and a researcher, Sackler School of Medicine, Tel Aviv University, Israel. He conducted the study in collaboration with Eran Hadar, MD, and Rinat Gabbay-Benziv, MD.

    Women were excluded from the study if the pregnancy was complicated by non-vertex presentation, multiple gestations, or chromosomal or major structural anomalies.  A majority of women (53.4%) in the study population underwent induction of labor for fetal indications (eg., suspected fetal growth restriction below the 10th percentile, oligohydramnios, fetal macrosomia, cholestasis of pregnancy, or pregnancy beyond 41 gestational weeks.

    Dr Hiersch noted that while prior studies investigated outcomes of labor induction among women who were of advanced maternal age or who were nulliparous, there was a place for a study to address whether the combination of both obstetrical risk factors affected the labor induction failure rate.



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