Outcomes of labor induction in primiparous women with unfavorable cervical status at gestational week 41 and beyond. Does the Bishop score matter?

OBJECTIVES In Sweden, induction practices have shifted, and since 2020, national guidelines recommend induction of labor (IOL) at 41 gestational weeks. This study aimed to examine mode of delivery, childbirth experience and breastfeeding initiation among primiparous undergoing IOL at gestational week ≥41+0 with a Bishop score (BS) of 0-5.

MATERIAL AND METHODS This cohort study was based on prospectively collected data from medical records of 348 healthy primiparous with singleton pregnancies who underwent IOL at ≥ 41 + 0 weeks of gestation with a BS of 0-5. Outcomes included mode of delivery, childbirth experience, and breastfeeding. Women were divided into two categories according to their cervical status: very unfavorable score (BS 0-3) and moderately unfavorable score (BS 4-5). Outcomes were compared using descriptive statistics and logistic regression, with odds ratios (OR) and 95% confidence intervals (CI).

RESULTS Emergency cesarean section (CS) was significantly more frequent among women with BS 0-3 compared to BS 4-5 (23% vs. 11%; OR 2.58, 95% CI 1.30-5.11). A negative childbirth experience (VAS < 5) was reported twice as often in the BS 0-3 group (20% vs. 10%; OR 2.08, 95% CI 1.03-4.20). No significant differences were found in the initiation of breastfeeding.

CONCLUSIONS Induction of labor in healthy primiparous with a BS of 0-3 at or beyond 41 weeks is associated with an increased risk of emergency cesarean section and negative childbirth experience. These findings underscore the clinical importance of various degrees of cervical ripeness before induction.