Background: Labour induction is a common obstetric intervention used to initiate uterine contractions before spontaneous labour begins. While medically indicated inductions can reduce maternal and fetal complications, inappropriate or poorly timed inductions may increase the risk of cesarean section (CS). Understanding how specific indications for induction affect CS risk is critical for optimizing clinical decision-making and improving maternal outcomes.

Objectives: This study aimed to assess the relationship between various indications for labour induction and the likelihood of cesarean delivery, while controlling for maternal, fetal, and obstetric factors.

Methods: A retrospective cohort study was conducted using delivery records from a tertiary maternity hospital between 2019 and 2024. Women with singleton pregnancies at ≥37 weeks who underwent labour induction were included. Indications for induction were categorized as medical (e.g., hypertensive disorders, diabetes, and fetal growth restriction) or elective (e.g., post-dates, maternal request). Logistic regression models were applied to estimate adjusted odds ratios (aORs) for cesarean section across indication groups, adjusting for confounders such as maternal age, parity, Bishop Score, and gestational age.

Results: Among 2,150 induced labours, the overall cesarean rate was 28.4%. Inductions for hypertensive disorders and suspected fetal compromise were associated with higher CS risk (aOR 2.1, 95% CI 1.6–2.8; and aOR 1.8, 95% CI 1.3–2.5, respectively) compared to post-dates induction. In contrast, elective inductions with favorable cervical conditions showed no significant increase in CS risk (aOR 1.1, 95% CI 0.8–1.5). A low Bishop score at induction onset remained a strong independent predictor of cesarean delivery.