Factors affecting success of vaginal delivery in nulliparous patients receiving magnesium sulfate during labor induction.
Lee. Daniel D; Negi. Masaru M; Mei. Jenny Y JY
Key Findings
- Younger age, lower BMI, higher gestational age and higher Bishop’s score were linked to successful vaginal delivery
- Artificial rupture of membranes (aOR 1.30) and oxytocin administration (aOR 1.27) increased odds of vaginal delivery
- Vaginal delivery reduced maternal hemorrhage, blood transfusion, and overall maternal and neonatal complications
Practical Outcomes
- For obstetric care, adding oxytocin and performing artificial rupture of membranes can help more women with severe preeclampsia achieve vaginal birth, which lowers the risk of bleeding and newborn complications. However, these findings are specific to high‑risk pregnancy settings and have limited direct relevance for longevity or performance‑focused biohackers.
Summary
In a large U.S. study of first‑time moms with severe preeclampsia who got magnesium sulfate during labor induction, about half delivered vaginally. Women who were younger, slimmer, further along in pregnancy, and had a higher Bishop’s score were more likely to have a vaginal birth. Using artificial rupture of membranes or giving oxytocin also raised the chances of vaginal delivery, and vaginal birth was linked to fewer bleeding problems and better newborn scores.
Abstract
Magnesium sulfate administration for preeclampsia with severe features during labor induction has been associated with increased risk of cesarean delivery (CD). We aim to evaluate associations with successful vaginal delivery (VD) in nulliparous patients undergoing labor induction while receiving magnesium sulfate. This was a secondary analysis from the Consortium on Safe Labor, a multicenter cohort study of 228,438 deliveries in 19 U.S. hospitals. The analysis included nulliparous women ≥18 years old with singleton gestation undergoing induction of labor for preeclampsia with severe features and receiving magnesium sulfate. Primary outcome was characteristics associated with successful VD. Secondary outcomes were maternal and neonatal outcomes. Chi-square and independent samples <i>t</i>-tests were used to compare groups. Multivariate logistic regression was performed to adjust for baseline characteristics that differed between groups. A total of 4122 women met inclusion criteria, of whom 2256 (54.7%) had a VD. Patients who had a VD were more likely to have lower maternal age (24.8 ± 5.7 years vs. 27.0 ± 6.6 years; <i>p</i> < 0.001) and BMI (25.9 ± 6.5 kg/m<sup>2</sup> vs. 27.8 ± 7.4 kg/m<sup>2</sup>; <i>p</i> < 0.001), higher gestational age (36w1 ± 4d vs. 35w ± 0d; <i>p</i> < 0.001), and lower admission systolic blood pressure (142.4 mmHg ± 17.2 vs. 146.0 mmHg ± 18.4; <i>p</i> = 0.049). Labor factors associated with VD included higher Bishop's score on admission (5.0 ± 3.1 vs. 3.2 ± 2.5; <i>p</i> < 0.001) and undergoing artificial rupture of membranes (aOR, 1.30; 95% confidence interval (CI), 1.02-1.65; <i>p</i> = 0.036) or oxytocin administration (aOR, 1.27; 95% CI, 1.07-1.50; <i>p</i> = 0.006). Successful VD was associated with lower postpartum hemorrhage (aOR, 0.15; 95% CI, 0.11-0.21; <i>p</i> < 0.001), blood transfusion (aOR, 0.61; 95% CI, 0.43-0.87; <i>p</i> = 0.007), and composite maternal morbidity (aOR, 0.66; 95% CI, 0.49-0.90; <i>p</i> = 0.009). In neonatal outcomes, VD was associated with higher one-minute APGAR (7.3 ± 2.1 vs. 6.8 ± 2.2; <i>p</i> < 0.001), and lower rates of NICU admission (aOR, 0.46; 95% CI, 0.39-0.55; <i>p</i> < 0.001) and composite neonatal morbidity (aOR, 0.66; 95% CI, 0.55-0.80; <i>p</i> < 0.001). Rates of CD are high in patients undergoing induction of labor for preeclampsia with severe features and receiving magnesium sulfate. Various characteristics are associated with an increased rate of successful VD. Appropriate care should be taken in labor management for this high-risk patient cohort.
Study Information
pubmed
2025
2025-11-19T00:00:00.000Z
10.1080/14767058.2025.2589635
35