Induction of labour for postdate pregnancy in Asian women: outcome analysis

Abstract

Introduction NICE guideline on induction of labour (IOL) at/ or beyond 41 weeks gestation is based on the evidence that IOL is associated with reduced perinatal morbidity/mortality and does not result in increased Caesarean deliveries. This recommendation however does not take into account the ethnic variation in gestational length. Aim To assess outcome of postdate pregnancy among a group of Asian women who underwent planned induction of labour. Materials and Methods Retrospective review of case notes of consecutive 300 Asian women with uncomplicated post dates pregnancy who were planned for IOL. Results 207 (69.4%) women went into spontaneous labour while waiting for IOL. 71% had spontaneous vaginal delivery, 23% instrumental deliveries and 6% emergency Caesarean section. 93 (30.6%) women had IOL with vaginal Prostin, in 46.6% cases and artifi cial rupture of membranes followed by Syntocinon infusion in 13.4% cases. 81% had spontaneous vaginal delivery, 2% forceps delivery and 17% emergency Caesarean section. Average gestational length in he induction group was 40+12 weeks and 40+8 weeks in spontaneous labour group. Discussion Recent evidence suggesting that Asian women, who may have gestational length 1 week shorter than the Caucasian, should be considered for early IOL. An early induction policy may help to reduce the risk of increased Caesarean delivery in this group of women. As NICE guideline on IOL does not take into account that gestational length can vary between ethnic groups, there is need for research to determine an induction policy in this group

The Effect of Ethnic Variation on the Success of Induced Labour in Nulliparous Women with Postdates Pregnancies

“…A Cochrane review has also reported that inducing labour at 41 weeks of gestation does not increase the caesarean section (CS) rates and leads to improved perinatal outcomes [ 5 ]. However, the NICE recommendation in 2008 does not take into account the significant influence of ethnic variation on the obstetric and perinatal outcome [ 6 , 7 ]. There is evidence that normal gestational length is shorter by a week in Black and Asian women when compared with White European women and that fetal maturation occurs earlier [ 8 ].…”