4.3 Article

Labor induction and augmentation in women with multiple sclerosis

Journal

MULTIPLE SCLEROSIS JOURNAL
Volume 19, Issue 9, Pages 1182-1189

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/1352458512474090

Keywords

Multiple sclerosis; cohort studies; labor; birth; pregnancy; childbirth

Funding

  1. Canadian Institutes of Health Research [MOP-106607]
  2. Canadian Institutes of Health Research
  3. Multiple Sclerosis Society of Canada
  4. National Multiple Sclerosis Society
  5. University of British Columbia MS/MRI Research Group
  6. Dr. Donald Paty

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Background: Fatigue and pelvic organ dysfunction are common among women with multiple sclerosis (MS), which may prolong labor and increase the risk of labor induction and/or augmentation. Objective: We set out to investigate the association between MS and related clinical factors (disease duration and the Expanded Disability Status Scale, EDSS) with labor induction/augmentation. Methods: Data from the British Columbia (BC) MS database were linked with the BC Perinatal Database Registry. Multivariable models were used to compare the likelihood of labor induction and augmentation between attempted vaginal deliveries (1998-2009) in women with MS (n=381) and the general population (n=2615). Results: In the MS cohort, 94/381 deliveries (25%) required labor induction and 147/381 deliveries (39%) required labor augmentation. Having MS was not associated with labor induction (adjusted odds ratio (OR)=0.91; 95% confidence interval (CI)=0.68-1.22, p=0.54) or augmentation (adjusted OR=0.91; 95% CI=0.72-1.15, p=0.43), but was associated with multiple methods of labor induction (OR=1.94; 95% CI=1.23-3.06, p=0.004). A higher EDSS score was associated with an increased risk of labor induction (adjusted p=0.04), but not labor augmentation (adjusted p > 0.5). Disease duration was not associated with either outcome (adjusted p > 0.2). Conclusions: Greater intervention may be required to initiate labor for women with a higher degree of disability due to MS.

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