Induction of labour for improving birth outcomes for women at or beyond term

Abstract

Background As a pregnancy continues beyond term the risks of babies dying inside the womb or in the immediate newborn period increase. Whether a policy of labour induction at a predetermined gestational age can reduce this increased risk is the subject of this review. Objectives To evaluate the benefits and harms of a policy of labour induction at term or post-term compared with awaiting spontaneous labour or later induction of labour. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (31 March 2012). Selection criteria Randomised controlled trials conducted in women at or beyond term. The eligible trials were those comparing a policy of labour induction with a policy of awaiting spontaneous onset of labour. Cluster-randomised trials and cross-over trials are not included. Quasi-random allocation schemes such as alternation, case record numbers or open random-number lists were not eligible. Data collection and analysis Two review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. Outcomes are analysed in two main categories: gestational age and cervix status. Main results We included 22 trials reporting on 9383 women. The trials were generally at moderate risk of bias. Compared with a policy of expectant management, a policy of labour induction was associated with fewer (all-cause) perinatal deaths: risk ratio (RR) 0.31, 95% confidence interval (CI) 0.12 to 0.88; 17 trials, 7407 women. There was one perinatal death in the labour induction policy group compared with 13 perinatal deaths in the expectant management group. The number needed to treat to benefit (NNTB) with induction of labour in order to prevent one perinatal death was 410 (95% CI 322 to 1492). For the primary outcome of perinatal death and most other outcomes, no differences between timing of induction subgroups were seen; the majority of trials adopted a policy of induction at 41 completed weeks (287 days) or more. Fewer babies in the labour induction group had meconium aspiration syndrome (RR 0.50, 95% CI 0.34 to 0.73; eight trials, 2371 infants) compared with a policy of expectant management. There was no statistically significant difference between the rates of neonatal intensive care unit (NICU) admission for induction compared with expectant management (RR 0.90, 95% CI 0.78 to 1.04; 10 trials, 6161 infants). For women in the policy of induction arms of trials, there were significantly fewer caesarean sections compared with expectant management in 21 trials of 8749 women (RR 0.89, 95% CI 0.81 to 0.97). Authors’ conclusions A policy of labour induction compared with expectant management is associated with fewer perinatal deaths and fewer caesarean sections. Some infant morbidities such as meconium aspiration syndrome were also reduced with a policy of post-term labour induction although no significant differences in the rate of NICU admission were seen. However, the absolute risk of peri...

Induction of labour at Jos University teaching, hospital, Jos, Nigeria: a four year review

“…24 Another study has indicated that induction may increase the risk of caesarean section if performed before the 40th week of gestation, but it has no effect or actually lowers the risk if performed after the 40th week. 25,26 while some recent reviews regarding IOL and its effect on Cesaerean section rates do indicate that there is no significant increase in IOL rates but on the contrary there can be a reduction in Caeserean section rates with IOL.…”

Which method is best for the induction of labour? A systematic review, network meta-analysis and cost-effectiveness analysis

“…Note that to obtain the utility scores for the mother's perspective only the first term is used for each state, whereas for the utilities from the baby's perspective only the second term is used for each state. (2,3,1,0.5,1.5, 2,1.5,2,3), d=c (NA,5,4,2,3,1,3,4,5)) DOI: 10.3310/hta20650 HEALTH TECHNOLOGY ASSESSMENT 2016 VOL. 20 NO.…”

Intervention or interference? The need for expectant care throughout normal labour

“…Induction for 'post- antenatal fetal monitoring should be made available. 2 Induction at or beyond 41 weeks is thus phrased as an option, not a practice to be strongly encouraged for all women, and induction for postmaturity before 41 weeks is not recommended and shows no benefits. As induction of labour with oxytocin is associated with a greater need for epidural analgesia, 3 it is presumably more painful and thus should be avoided unless necessary.…”