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Biunsu 1213corresponding increase of two in the number of deaths from trauma, stress asphyxia in labour, and cord entanglement, and an increase of three in the " premature, cause unknown" group. The number of deaths due to antepartum haemorfhage (unrelated to hypertension and preeclampsia) has not altered.In the induced group a relatively large number of foetal deaths were attributed to maternal hypertension and preeclampsia. However, the number was no higher than would be expected as a result of the high incidence of these conditions in women who were induced. Fig. 2 shows that the overall foetal death rate has remained virtually stati-, despite the marked increase in the induction rate. The combined stillbirth and neonatal death rate in the induced group fell gradually until, in 1955, it was actually lower than the total figure for all deliveries.No doubt this fall is due to the increasing number of inductions performed for minor indications; nevertheless the conditions for which induction was performed constitute a distinct danger to the baby. It may be misleading to draw any firm conclusions from this trend, but a balance sheet can be drawn up summarizing the points which have been made for and against induction.For InductionAgainst Induction 1. Reduction of the stillbirth 1. Overall stillbirth and neoand neonatal death rate in the natal death rate has not induced group to that of the apparently improved. whole group.2. 10-15% risk of caesarean 2. The overall caesarean sec-section after induction. tion rate has not increased.3. Slightly increased morbidity rate.4. Psychological trauma.Until the placental reserve can be measured, a large number of women with adequate placental function will be induced to save a few infants from placental insufficiency. A number of hospitals have reported induction rates of over 20%. They have achieved caesarean section rates after induction of under 5% by allowing the latent period to exceed 72 hours in many cases. They are thus submitting many infants to a danger far greater than that of allowing pregnancy to continue. Once surgical induction has been performed, delivery should be effected within three days. SummaryAn analysis has been made of the effect of the sevenfold increase in the rate of surgical induction of labour at Hammcrsmith Hospital during the period 1951 to 1956. The risk to the mother is that of caesarean section. The caesarean section rate after induction was 14.5 % against an overall rate of 5.4%. Caesarean section was carried out when labour was not established within 72 hours. In spite of this policy and the rising induction rate, the overall caesarean section rate did not increase.The incidence of puerperal pyrexia was 9.1 % against the overall rate of 5.3 %. This increase was entirely associated with the higher caesarean section rate.The increased induction rate has not apparently effected a reduction in the overall foetal mortality during the period under review.We thank Professor 3. C. McClure Browne for permission to publish this material, and we are...

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