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 postterm 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 randomnumber 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

Rates of labor induction and primary cesarean delivery do not correlate with rates of adverse neonatal outcome in level I hospitals

“…Following adjustment, there was a positive association between IOL and PCD. This is consistent with several other studies [15][16][17], although not for inductions after 41 weeks [18].…”

Postterm pregnancy

“…55 in Maternal-Fetal Evidence Based Guidelines). In addition, an effort should be made to assess fetal weight, either clinically or, if this assessment is limited, by ultrasound, as the known increase in fetal and neonatal mortality in pregnancies beyond their due date is even higher in IUGR fetuses (10,20).…”

“…Routine Induction of Labor at !41 Weeks A policy of labor induction at 41 completed weeks (41-41 6/7) or beyond is associated with significantly less perinatal deaths (1/2986 vs. 9/2953; RR 0.30, 95% CI 0.09-0.99) compared with expectant management, with induction not before 42 weeks (20,21). If deaths due to congenital abnormality are excluded, no deaths remain in the labor induction group and seven deaths remain in the no induction group.…”

When Should the Labor Induction be Started For Late-term Pregnancies, in the Morning or in the Evening?

“…At late term pregnancy period and beyond, both mother and baby are at increased risk of adverse events. Thus, most clinicians prefer to induce labor after 41 weeks of gestation [2][3]. Many different methods are used for the induction of labor according to cervical characteristics.…”

“…Many different methods are used for the induction of labor according to cervical characteristics. Among these protocols, induction with intravenous oxytocin is often carried out as the cervix is favourable (usually a Bishop score of six or more) [3]. Due to the personal availability, obstetricians generally plan to deliver pregnant women during office hours.…”