Indications for labor induction. Differences between university and community hospitals.

OBJECTIVE: To compare the rates of and indications for labor induction between a university hospital and two community hospitals and to examine the risk of cesarean delivery among labor induction cases. STUDY DESIGN: Labor induction cases over a six-month period were included (N = 536). Medical records were reviewed by a trained abstractor using a standardized form to determine maternal characteristics, reason for induction and perinatal outcomes. RESULTS: Rates of labor induction were significantly different between the three hospitals: university, 18.2%; community hospital A, 21.4%; community hospital B, 33.7% (P < .001). At the university hospital, 95% of labor inductions were medically indicated using American College of Obstetricians and Gynecologists (ACOG) criteria. Forty-four percent of labor inductions at community hospital A and 57% at community hospital B were for elective reasons. Cesarean rates among induction cases were highest at the university hospital (19%) as compared to community hospital A (15%) and community hospital B (11%), although the difference was not statistically significant. Parity, race and cervical status, but not elective induction, were significantly associated with cesarean delivery. CONCLUSION: Labor induction was more frequent in community hospitals but more likely to meet ACOG-approved indications at the university hospital. The more-frequent inductions at the community hospitals did not result in higher cesarean rates.

Low backache during pregnancy. Acute hemodynamic effects of a lumbar support.

OBJECTIVE: To determine whether a commercially available elastic/Velcro lumbar and abdominal support (Mother-To-Be, CMO, Inc., Barberton, Ohio) affects the hemodynamics of the fetus and pregnant woman. STUDY DESIGN: Healthy volunteers with low backache at 24-36 weeks' gestation were sought from our obstetric clinic population. The fetal heart rate (FHR), maternal blood pressure and maternal cardiac output were monitored for 20-minute intervals before, during and after placement of the support while standing and sitting. A sufficient number of subjects was used to detect a difference of 10% in cardiac output. RESULTS: Twenty-five women were enrolled between 24 and 36 weeks' gestation. No significant changes were encountered in the FHR baseline or beat-to-beat variability during placement of the support. The few FHR decelerations were isolated and not attributable to the support. The maternal systolic, diastolic and mean arterial blood pressures were unaffected by the support. The right-sided and left-sided cardiac outputs were unchanged during the monitoring periods. Each woman, when questioned two weeks later, reported improvement in back discomfort while sitting and standing. CONCLUSION: This elastic/Velcro lumbar and abdominal support, available to relieve low backache, did not acutely affect the hemodynamics of the fetus and mother.