Is preeclampsia associated with an increased risk of cesarean delivery if labor is induced?

Objective. To determine whether preeclampsia is associated with an increased risk of cesarean delivery if labor is induced. Methods. This retrospective cohort study of 3505 women ≥24 weeks gestation with singleton pregnancies undergoing labor induction compares cesarean delivery rates between preeclamptics and non-preeclamptics. Multivariable logistic regression analysis was used to control for potential confounders including unfavorable cervix (Bishop score ≤5), method of labor induction, maternal age, parity, gestational age, race/ethnicity, epidural use, medical insurance, and marital status. Results. Among term nulliparous women undergoing labor induction, preeclamptics had a higher cesarean delivery rate then non-preeclamptics (81/267, 30% vs.363/1568, 23%; p=0.011), as did preeclamptic compared with non-preeclamptic women who were term and multiparous (10/64, 16% vs.55/900, 6%, p=0.003). Preterm preeclamptics also had more cesarean deliveries compared with non-preeclamptics among nulliparous (48/164, 29% vs.16/245, 7%; p<0.001) and multiparous (13/72, 18% vs.18/225, 8%; p=0.015) women. In multivariable analysis, preeclampsia still conferred an increased risk of cesarean delivery if labor was induced (adjusted odd ratio=1.90, 95% CI 1.45-2.48). Conclusion. Women with preeclampsia undergoing labor induction had higher cesarean delivery rates compared with non-preeclamptics regardless of parity or gestational age. However, the majority of women with preeclampsia still had successful vaginal deliveries.