Labor induction: change of indications and outcomes over time and future trends — a retrospective analysis

Background: The purpose of this study was to evaluate the results of induction of labor over time in order to identify future trends. Methods: Data were collected from a national database for University Medical Center Maribor on the pregnant women demographics, the indications for labor induction, the process of induction and delivery, and the outcomes of delivery for periods 2011‒14 and 2015‒18. Results: In the second period (2015‒18), the rate of labor induction increased (14.7% vs. 19.0%, p < 0.00001), pregnant women were older (29.7 years vs. 30.0 years, p = 0.0018), were more frequently monitored in tertiary hospitals during pregnancy (40.6% vs. 80.7%, p < 0.00001), had hypertension in pregnancy (5.4% vs. 2.7%, p = 0.0002), and oligohydramnios (9.6% vs. 6.9% , p = 0.007). During labor, amniotomies (60.3% vs. 53.7%, p = 0.0004), umbilical cord prolapses (1.2% vs. 0.1%, p = 0.0003), meconium amniotic fluids (12.7% vs. 8.8%, p = 0.0008), pathological CTG tracings (15.2% vs. 8.4%, p < 0.00001) were less frequent. There were less episiotomies (37.4% vs. 29.1%, p < 0.00001), vacuum extractions (4.2% vs. 2.8%, p = 0.049), while the rate of caesarean sections remained constant (15.0% vs. 16.6%, p = 0.23). Conclusions: There is a tendency toward increased induction of labor (IOL) rates, probably related to higher average age of women, but with better delivery outcomes. Our findings reflect local practice and cannot be generalized.