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Am J Perinatol 2023; 40(16): 1725-1731
DOI: 10.1055/a-2099-4395
SMFM Fellowship Series Article

Predicting Spontaneous Labor beyond 39 Weeks among Low-Risk Expectantly Managed Pregnant Patients

Ayodeji Sanusi 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Yuanfan Ye
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Ashley N. Battarbee 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Rachel Sinkey
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Rebecca Pearlman
4   School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Danyon Beitel
4   School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. N. Tita
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Funding A.N.B. was supported by K23HD103875 from the NICHD during the study. The other authors report no financial support.
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Abstract

Objectives The aim of the study was to identify the characteristics associated with spontaneous labor onset in pregnant patients undergoing expectant management at greater than 39 weeks' gestation and delineate perinatal outcomes associated with spontaneous labor compared with labor induction.

Study Design This was a retrospective cohort study of singleton pregnancies at ≥390/7 weeks' gestation delivered at a single center in 2013. The exclusion criteria were elective induction, cesarean delivery or presence of a medical indication for delivery at 39 weeks, more than one prior cesarean delivery, and fetal anomaly or demise. We evaluated prenatally available maternal characteristics as potential predictors of the primary outcome-spontaneous labor onset. Multivariable logistic regression was used to generate two parsimonious models: one with and one without third trimester cervical dilation. We also performed sensitivity analysis by parity and timing of cervical examination, and compared the mode of delivery and other secondary outcomes between patients who went into spontaneous labor and those who did not.

Results Of 707 eligible patients, 536 (75.8%) attained spontaneous labor and 171 (24.2%) did not. In the first model, maternal body mass index (BMI), parity, and substance use were identified as the most predictive factors. Overall, the model did not predict spontaneous labor (area under the curve [AUC]: 0.65; 95% confidence interval [CI]: 0.61–0.70) with high accuracy. The addition of third trimester cervical dilation in the second model did not significantly improve labor prediction (AUC: 0.66; 95% CI: 0.61–0.70; p = 0.76). These results did not differ by timing of cervical examination or parity. Patients admitted in spontaneous labor had lower odds of cesarean delivery (odds ratio [OR]: 0.33; 95% CI: 0.21–0.53) and neonatal intensive care unit (NICU) admission (OR: 0.38; 95% CI: 0.15–0.94). Other perinatal outcomes were similar between the groups.

Conclusion Maternal characteristics did not predict spontaneous labor onset at ≥39 weeks' gestation with high accuracy. Patients should be counseled on the challenges of labor prediction regardless of parity and cervical examination, outcomes if spontaneous labor does not occur, and benefits of labor induction.

Key Points

  • Majority of patients will attain spontaneous labor at ≥39 weeks.

  • Maternal characteristics do not predict labor at ≥39 weeks.

  • Spontaneous labor has associated lower perinatal risks.

  • A shared decision model should be utilized in counseling patients who may choose expectant management.

Keywords

labor induction - labor prediction - spontaneous labor - expectant labor management

Note

Presented at the 41st Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine, January 25–30, 2021 (abstract no.: 1,138).


Supplementary Material



Publication History

Received: 19 July 2022

Accepted: 22 May 2023

Accepted Manuscript online:
24 May 2023

Article published online:
28 June 2023

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