{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:34:46Z","timestamp":1780731286297,"version":"3.54.1"},"reference-count":9,"publisher":"Georg Thieme Verlag KG","issue":"09","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["NIAID K08AI141728"],"award-info":[{"award-number":["NIAID K08AI141728"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003This study aimed to quantify the relative maternal and fetal risks and benefits of continuing labor induction.<\/jats:p><jats:p>\n          Study Design\u2003This retrospective cohort study included nulliparous women with nonanomalous, singleton, vertex, term pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. The primary outcome was mode of delivery. Secondary outcomes included hemorrhage, transfusion, infection, and composite neonatal morbidity. The data were analyzed using chi-square and Fisher's exact tests. Multivariable regression was used to control for potential confounders.<\/jats:p><jats:p>\n          Results\u2003A total of 955 patients met the inclusion criteria. The median induction duration was 32.3\u2009hours (interquartile range: 20.4\u201341\u2009hours) and the vaginal delivery rate was 70.5% (n\u2009=\u2009673). The chance of vaginal delivery at 12, 24, 36, 48, 60, and \u226560\u2009hours was 76, 83, 77, 74, 72, and 48%, respectively. After controlling for confounders, there was a 20% decrease in chance of vaginal delivery with induction \u2265 24\u2009hours compared with induction\u2009&lt;\u200924\u2009hours. The adjusted relative risks of hemorrhage, transfusion, and infection with induction \u2265 24\u2009hours compared with induction\u2009&lt;\u200924\u2009hours were 1.9, 2.2, and 2.7, respectively (95% confidence interval [CI] of 1.4\u20132.5, 1.1\u20133.9, and 1.8\u20134.0, respectively). The relative risk for these outcomes remained stable or decreased at each subsequent time point. The increasing risks of hemorrhage and infection were primarily among patients who underwent cesarean delivery. There was no association between induction duration and neonatal morbidity.<\/jats:p><jats:p>\n          Conclusion\u2003In this cohort, the chance of vaginal delivery remained nearly 50% even when induction extended beyond 60\u2009hours. Risks of hemorrhage and maternal infection rose modestly over time, but primarily in patients who underwent cesarean delivery. There was no difference in the risk of transfusion beyond 24\u2009hours and no association between induction duration and neonatal morbidity. These findings may be useful when engaging patients in shared decision-making during labor induction.<\/jats:p>","DOI":"10.1055\/s-0039-1701025","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T23:58:53Z","timestamp":1580774333000},"page":"935-943","source":"Crossref","is-referenced-by-count":4,"title":["Quantifying the Risks and Benefits of Continuing Labor Induction: Data for Shared Decision-Making"],"prefix":"10.1055","volume":"38","author":[{"given":"Elizabeth Nicole","family":"Teal","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam K.","family":"Lewkowitz","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.P.","family":"Koser","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol B.N.","family":"Tran","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie L.","family":"Gaw","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.1097\/AOG.0000000000003083","article-title":"ACOG Committee Opinion No. 764: medically indicated late-preterm and early-term deliveries","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1056\/NEJMoa1800566","article-title":"Labor induction versus expectant management in low-risk nulliparous women","volume":"379","author":"W A Grobman","year":"2018","journal-title":"N Engl J Med"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.ajog.2006.07.003","article-title":"Induction of labor and cesarean delivery by gestational age","volume":"195","author":"A B Caughey","year":"2006","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref4","first-page":"207","article-title":"The safe prevention of the primary cesarean","volume":"58","author":"A B Caughey","year":"2015","journal-title":"Clin Obstet Gynecol"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1097\/01.AOG.0000157437.10998.e7","article-title":"When has an induction failed?","volume":"105","author":"C E Simon","year":"2005","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1097\/AOG.0b013e318207887a","article-title":"Failed labor induction: toward an objective diagnosis","volume":"117","author":"D J Rouse","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"122.e1","DOI":"10.1016\/j.ajog.2017.11.556","article-title":"Defining failed induction of labor","volume":"218","author":"W A Grobman","year":"2018","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1055\/s-0038-1675642","article-title":"Assessing maternal and fetal risks associated with prolonged induction of labor","volume":"36","author":"J E Triebwasser","year":"2019","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1097\/AOG.0000000000002351","article-title":"Practice Bulletin No. 183: postpartum hemorrhage","volume":"130","year":"2017","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1701025.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,15]],"date-time":"2021-07-15T16:22:33Z","timestamp":1626366153000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1701025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,3]]},"references-count":9,"journal-issue":{"issue":"09","published-online":{"date-parts":[[2021,7,13]]},"published-print":{"date-parts":[[2021,7]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1701025","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2,3]]}}}