Background Despite a lack of high-quality evidence, the use of 'non-indicated' term labour induction is increasingly restricted throughout the world.Objectives To assess published associations between the regular use of modelled risk-based 'non-indicated' term labour induction (hereinafter 'preventive induction') and rates of common adverse birth outcomes.Search strategy MEDLINE and PUBMED databases were searched electronically.Selection criteria Studies were identified that compared term birth outcomes following either the current standard approach with its emphasis on the expectant management of intermediate-level risk or the regular use of preventive induction.Data collection and analysis Four studies from four unique databases were identified. A meta-analysis was performed using STATA IC12.Main results Pregnancies exposed to the regular use of preventive induction (n = 1153), as compared with pregnancies receiving the current standard approach (n = 1865), experienced a lower caesarean delivery rate (5.7% versus 14.4%; relative risk 0.39, 95% CI 0.31-0.50; I 2 P = 0.21), a lower neonatal intensive care unit admission rate (2.9% versus 6.5%; relative risk 0.45, 95% CI 0.31-0.65; I 2 P = 0.57), and a lower weighted adverse outcome index score (2.8 versus 6

Topic: Neonatal Morbidity and Mortality, Maternal Morbidity and MortalityT he rate of labor induction in the United States increased from 9.5% to 23.4% between 1990 and 2010, and the rate of cesarean delivery (CD) rose from 23% to 32.9% over the same period. During that time, many observational studies reported associations between induction of labor (IOL) and both CD and neonatal intensive care unit (NICU admission). In addition, associations between IOL and early-term birth and higher rates of neonatal morbidity and mortality have been reported. This led to a restriction on "non-indicated" induction (ni-IOL) before the 39th week of gestation, leading to a significant decrease in the rates of ni-IOL. However, the impact of lower rates of labor induction on term births is unknown, and several recent studies have disputed the association between ni-IOL and adverse outcomes. Indeed, 5 studies published between 2004 and 2009 comparing the outcomes of nonindicated but risk-based IOL [preventive or (p-IOL)] within the Active Management of Risk in Pregnancy at Term (AMOR-IPAT) system with standard care showed significant associations between regular use of p-IOL and lower rates of common adverse birth outcomes. This review and meta-analysis combined data from all published AMOR-IPAT-type studies to reevaluate the potential impact of p-IOL on common adverse birth outcomes.The authors performed a literature search of both OVID-Medline (1996 to present) and PubMed for key terms, including "preventive labor induction," "risk-based labor induction," and "AMOR-IPAT" to identify relevant studies. Only studies where women were given the option of p-IOL before hospital admission were included. After compiling published data from identified studies to form a composite database, the authors compared levels of reported demographic factors, prenatal variables, and rates of group outcomes using a random-effects model and w 2 techniques. Rates of CD were compared on the basis of parity status, and risk ratios for various adverse outcomes were determined from the composite database. Data were also combined using 2 composite childbirth outcome-scoring schemes, the Weighted Adverse Outcome Index (WAOI) and the Uncomplicated Vaginal Delivery (UVD) Rate.The literature search yielded 4 studies from 4 unique databases that were included in the final analysis, encompassing 3020 total pregnancies (1153 p-IOL, 1867 "normal care") spanning a period of 13 years (1994 to 2006). The group exposed to p-IOL had an overall induction rate that was 92% higher than that of the normal care group, as well as a much higher rate of ni-IOL, most of which were preventive in nature. Despite the higher ni-IOL rate, the exposed group experienced a 60% lower rate of CD, a 55% lower rate of NICU admission, and a 23% lower rate of third-degree or fourth-degree perineal laceration. No adverse birth outcomes occurred at a statistically significant higher rate in the exposed group, nor were there any serious adverse birth outcomes that trended higher. In addition, the...