Induction of labour versus expectant management after one previous caesarean birth maternal and neonatal outcomes in a population-based cohort study

Abstract To investigate maternal and neonatal outcomes after induction of labour (IOL), across all indications, compared with expectant management at term among women with prior caesarean section (CS). Women with one prior CS planned for vaginal birth 2007–2020 (N = 38 689). IOL was investigated as a continuum in days and compared with expectant management (EM; onset of birth one day or more later). The risk of severe and moderate maternal and neonatal outcomes at gestational week 37–42 was compared between IOL and EM using a multivariable logistic regression model. Results are presented as adjusted absolute risks, relative risks, and adjusted risk differences (aRD), with 95% confidence intervals (CIs). IOL compared to EM increased the risk of CS with the maximum at 40 weeks (aRD 5.5%, 95% CI 3.0;6.6). The risk of severe maternal and neonatal outcomes increased with gestational age (p < 0.001), without difference between IOL and EM. Moderate severe neonatal outcomes were increased at week 37 (aRD 3.8, 95% CI 1.4;7.4) but reduced with IOL at week 39 (aRD − 1.0, 95% CI -1.6;-0.3). For women with prior CS, IOL at weeks 39–41 was associated with unplanned CS. Timing of birth influence neonatal outcomes.