Objective. To identify potential risk factors for cesarean delivery following labor induction in multiparous women at term. Methods. We conducted a retrospective case-control study. Cases were parous women in whom the induction of labor had resulted in a cesarean delivery. For each case, we used the data of two successful inductions as controls. Successful induction was defined as a vaginal delivery after the induction of labor. The study was limited to term singleton pregnancies with a child in cephalic position. Results. Between 1995 and 2010, labor was induced in 2548 parous women, of whom 80 had a cesarean delivery (3%). These 80 cases were compared to the data of 160 parous women with a successful induction of labor. In the multivariate analysis history of preterm delivery (odds ratio (OR) 5.3 (95% CI 1.1 to 25)), maternal height (OR 0.87 (95% CI 0.80 to 0.95)) and dilatation at the start of induction (OR 0.43 (95% CI 0.19 to 0.98)) were associated with failed induction. Conclusion. In multiparous women, the risk of cesarean delivery following labor induction increases with previous preterm delivery, short maternal height, and limited dilatation at the start of induction. 1. Introduction Induction of labor is a common and essential element of the contemporary obstetric practice and now accounts for approximately 20% of all deliveries [1–3]. Induction of labor is thought to be associated with an increase in the risk of cesarean delivery both for nulliparous and multiparous women [4]. This has been demonstrated both for inductions on medical grounds and for elective inductions [5, 6]. More recent randomized comparisons have demonstrated that the effect of the induction of labor on the risk of cesarean delivery is limited. In postterm women as well as in women with prolonged rupture of membranes at term and in women with hypertensive disease, induction of labor is more effective than expectant management [7–9]. Data in parous women undergoing labor induction have revealed conflicting results. Some observational studies suggest that the rate of cesarean delivery in multiparous women with an elective induction is similar to that in those women with a spontaneous onset of labor [6, 10, 11]. Other studies report an increased risk for those who were electively induced [12–15]. One recent study even reported a lower cesarean delivery rate in multiparous women in whom labor was induced preventively, in order to ensure that pregnant women entered labor at an optimal time for the mother-baby pair [16]. Not much is known about factors related to a cesarean
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