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.