Doctor: Pauline Blanc PetitJean

Title: Induction of labor in France : status of practices and evaluation of perinatal outcomes

Supervisors: Camillle Le Ray, François Goffinet

Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité

Date of thesis defense: 12/2019

Jury: Laurent Mandelbrot, Christophe Vayssière, Charles Garabedian, Jean Bouyer, Anne Rousseau.

Thesis summary:

  • Induction of labor is one of the most common obstetric interventions (22% of deliveries in France in 2016). Methods for induction of labor are various and previous data do not allow to define an ideal protocol of induction of labor. The overall objective of this thesis was to provide recent observational data on labor induction practices in France and on the effect of these practices on perinatal outcomes, using data from the MEDIP prospective population-based cohort study. First, the description of induction of labor practices in France highlighted an evolution of the methods of induction that were used and confirmed the persistence of a great heterogeneity of practices. Secondarily, we compared cesarean section rates according to women’s characteristics using a specific classification for induction of labor. Nulliparous women at term, with an immature cervix, were the groups most contributing to the cesarean section rate. This work has provided a framework for the study and comparison of induction of labor outcomes. Then, we pointed out that in common practice, none of the methods of cervical ripening frequently used in France appeared clearly superior to the others by balancing the effectiveness and safety of each method. Finally, women’s experience of induction of labor was assessed according to the method used. Cervical ripening was associated with a less positive experience of childbirth, whatever the methods of cervical ripening used, the majority of which not being explained by poorer medical outcomes of delivery. This work provides results on the evaluation of induction of labor practices in a context of routine care, complementary to those obtained in the context of experimentation. They might be useful to guide the clinicians and to inform women on induction of labor process and on its potential outcomes.
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