The Effect of Labour Induction on the Risk of Caesarean Delivery: Using Propensity Scores to Control Confounding by Indication

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(BJOG. 2016;123(9):1521–1529)Labor induction is sometimes undertaken when it is determined there may be potential benefit over expectant management for the mother or fetus, such as situations of preeclampsia, postterm pregnancy, oligohydramnios, or intrauterine growth restriction. Several research studies have been undertaken to understand the relationship between labor induction and an increased risk of cesarean delivery (CD). However, effect estimates for labor induction are often considered to be biased due to confounding by indication. This means the medical reason the patient underwent induction, such as preeclampsia, also increases the risk of CD. Thus, although induction might be found to be associated with an increased risk of CD, it might be the underlying condition, not the induction, accounting for this association. Propensity scores can be used to determine an individual’s predicted probability to be induced versus not to be induced. The present study aimed to limit the effect of confounding by indication in determining the association between labor induction and CD by using 2 propensity score methods, namely matching and adjustment.

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