Strengths & Limitations
The strength of the current study is the large and heterogeneous sample
size of pregnancies analyzed in both the induction of labor at 39 weeks
gestation group and the expectant management group. An additional
strength of the study is the data quality. The data collected and
analyzed is current, reliable, and includes data from the entirety of
the United States of America. Lastly, the study was adjusted for
significant confounders including, obesity, education, race and prior
vaginal delivery. Limitations of the study include the inability to
review indication for induction of labor, methods utilized for induction
of labor, bishop scores, fetal monitoring, severity of bleeding
requiring transfusion, severity of uterine rupture versus dehiscence,
and/or indications for intervention such as cesarean delivery. However,
it is assumed that there is enough similarity in practice as recommended
by ACOG that this would not directly impact the data collected. In
addition, there is no possibility of verifying the veracity of the data
obtained. Previous evaluation of the validity of this data supports it
is reliable and has a high degree of completeness and accuracy.29 If misclassifications occurs, they are likely to be
secondary to under reporting rather than over reporting. This therefore
would lead to higher baseline risk in the control population and
therefore an underestimation of the risk in the study population.