EBP Project Abstract
Appraised by: Sevil Aliyeva, KellyDeraas, and Morgan Johnson
Do pregnant women who have elective labor inductions at term (39-41 weeks) have an increased
risk of unplanned cesarean sections compared to those who go into spontaneous labor?
Ehrenthal,D.B., Jiang,X.,&Strobino, D.M.(2010). Labor induction and the risk of a cesarean delivery among nulliparous women at term. Obstetrics and gynecology, 116, (1), 35-42.
Jonsson, M., Cnattingius, S., & Wikstrom, A. (2013). Elective induction of labor and the risk of cesarean section in low-risk parous women: a cohort study. Acta Obstetricia Et Gynecologica Scandinavica, 92(2), 198-203.
Tam, T., Conte, M., Schuler, H., Malang, S., & Roque, M. (2013). Delivery outcomes in women undergoing elective labor induction at term. Archives of Gynecology and Obstetrics, 287, (3), 407-11.
Synthesis of Evidence:
All three studies were a level IV retrospective cohort studies. Ehrenthal, Jiang, and Strobino, (2010) used a total of 7804 women and labor induction was used in 43.6% of women. Elective labor induction was the method/intervention used in 39.9% of the women. The study was conducted over two years and seven months. Labor induction had increased the chances of unplanned cesarean sections by 20%. Jonsson, Cnattingius, and Wikstrom, (2013) conducted a study for parous women with no comorbidities or pregnancy complications. A total of 7973 women were used, and 343 women had elective labor induction. Out of the women who were electively induced, 52% failed to progress and had unplanned cesarean sections. Another complication was non-reassuring fetal heart rate which happened to 26% of electively induced women and lead to emergent cesarean sections. Elective inductions more than doubled the risk of unplanned cesarean sections. Tam, Conte, Schuler, Malang, and Rogue, (2013) conducted a study for low-risk women. A total of 848 pregnant women were included, with 694 of these women having a successful vaginal delivery and 154 having a caesarean delivery. Women who had a favorable cervical exam and multiparity had a greater chance of having a successful vaginal delivery. Studies showed a correlation between elective labor inductions and unplanned cesarean sections.
Bottom Line: (findings)
The evidence suggests that elective labor inductions increased the risk of unplanned cesarean sections.
Implications for Nursing Practice:
Nurses should be aware of the risks of elective labor inductions. The nurse educators and practitioners need to teach the staff about these risks and implement the teaching into the prenatal visits. Nurses and practitioners need to take the responsibility to inform the patient about the increased risks of cesarean sections due to elective inductions. Nurses need to be the advocate for the patient when the patient is not informed about the risks that go along with labor inductions. The nurses and practitioners have a duty to perform thorough assessments of the cervical condition and inform the patient if the cervix is not in favorable condition before discussing the option of labor induction. Nurses and practitioners should be aware of risk factors and co morbidities that can increase the risk of unsuccessful elective induction before they consider this option.