Severe preeclampsia and the very low birth weight infant: Is induction of labor harmful?

Objective: To compare the effects of labor induction with the effects of ce sarean delivery without labor on neonatal outcome in pregnancies complicate d by severe preeclampsia and delivery of very low birth weight infants. Methods: This tvas a retrospective study of 278 singleton, live-born infant s who weighed 750-1500 g and were delivered because of severe preeclampsia between 1988 and 1997. Outcomes of infants delivered by cesarean without la bor were compared with those of infants exposed to labor induction. Statist ical analysis was performed using Student t test, Mann-Whitney U test, chi( 2) analysis, and Fisher exact test, where appropriate. Multiple logistic re gression analysis was used to adjust for outcomes of interest. Results: One hundred forty-five (52%) of the 278 women with severe preeclam psia who delivered infants weighing between 750 and 1500 g had labor induce d and 133 (48%) delivered by cesarean without labor. Vaginal delivery was a ccomplished by 50 (34%) women in the induced group. Apgar scores of 3 or le ss at 5 minutes were more likely in the induced-labor group (6 versus 2%, P =.04), but other neonatal outcomes, including respiratory distress syndrom e, grade 3 or 4 intraventricular hemorrhage, sepsis, seizures, and neonatal death, were similar in the two groups. Adjustment for birth weight and ges tational age did not affect those results. Analysis of data from the induce d-labor group did not reveal an effect by route of delivery on neonatal out come. Conclusion: Induction of labor in cases of severe preeclampsia is not harmf ul to very low birth weight infants. (Obstet Gynecol 1999;93:485-8. (C) 199 9 by The American College of Obstetricians and Gynecologists.).