Health resource utilization of labor induction versus expectant management: Resource utilization at induction of labor.
Health resource utilization of labor induction versus expectant management: Resource utilization at induction of labor. American journal of obstetrics and gynecology 2020Abstract
BACKGROUND: Although induction of labor (IOL) 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: 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 multi-center randomized trial in which low-risk nulliparous women were assigned to IOL at 39 weeks or expectant management. We assessed resource utilization post-randomization in three time periods: antepartum (AP), delivery admission, and discharge through 8 weeks postpartum (PP).RESULTS: Of 6096 women with data available, those in the IOL group (n = 3059) were significantly less likely in the AP period after randomization to have at least one 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 one antepartum hospitalization (0.8% vs. 2.2%, p<0.001 for all). They also had fewer tests (e.g., sonograms, blood tests) and treatments (e.g., antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the IOL group spent a longer time in labor and delivery (median: 0.83 vs. 0.57 days), but both women (p=0.002) and their neonates (p<0.001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of PP urgent care and hospital readmissions (p>0.05 for all).CONCLUSIONS: Women randomized to IOL had longer durations in labor and delivery, but significantly fewer AP visits, tests, and treatments, and shorter maternal and neonatal hospital durations post-delivery. These results demonstrate that the health outcome advantages associated with IOL are gained without incurring uniformly greater health care resource use.
View details for DOI 10.1016/j.ajog.2020.01.002
View details for PubMedID 31930993