Background: Induction of labour (IOL) is a common obstetric intervention intended to achieve vaginal delivery when continuation of pregnancy poses risks to the mother or fetus. However, in nulliparous women, IOL is associated with a higher likelihood of cesarean delivery, particularly in the presence of certain maternal and obstetric risk factors. Understanding these predictors is essential for optimizing outcomes and guiding clinical decisions.

Aim: To identify maternal and obstetric risk factors associated with cesarean delivery following induction of labour in nulliparous women at term.

Methods: This hospital-based case-control study was conducted in the Department of Obstetrics and Gynaecology at Dr. Rajendra Prasad Government Medical College, Kangra at Tanda. A total of 200 nulliparous women at 37–42 weeks gestation who underwent IOL were enrolled, comprising 100 cases (emergency cesarean after IOL) and 100 controls (vaginal delivery after IOL). Data collected included demographic parameters, BMI, pre-induction Bishop score, indications for induction, obstetric risk factors, and maternal and neonatal outcomes. Statistical analysis was performed using chi-square and t-tests, with odds ratios (OR) and 95% confidence intervals (CI) calculated; p < 0.05 was considered significant.

Results: Higher BMI (≥25 kg/m²; OR = 2.96, p = 0.001), Bishop score <5 (OR = 4.09, p = 0.002), hypertensive disorders of pregnancy (OR = 2.60, p = 0.008), and diabetes mellitus (OR = 2.25, p = 0.040) were significantly associated with cesarean delivery after IOL. Acute fetal distress was the most common cesarean indication (72%), followed by failed induction (19%) and non-progression of labour (9%). Other factors, including maternal age ≥35 years, PROM, IUGR, oligohydramnios, and birth weight ≥3.5 kg, were not statistically significant predictors. Neonatal outcomes, including birth weight and NICU admission rates, were comparable between groups.