Randomized Trial of Labor Induction in Women 35 Years of Age or Older

Walker, Kate F.; Bugg, George; Macpherson, Marion; McCormick, Carol; Grace, Nicky; Wildsmith, Chris; Bradshaw, Lucy; Smith, Gordon Cs; Thornton, Jim

doi:10.1056/nejmoa1509117

Cited by 194 publications

(89 citation statements)

References 27 publications

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“…25–27 Increasing rates of maternal complications and arrest of labor, whether spontaneous or induced, are also seen with prolonged gestations. 20,28 While evidence suggests that induction of labor does not increase risk of cesarean delivery in the general population, 20,29 multiple studies have shown that obesity is a risk factor for failed induction. 16 Obese women have increased morbidity with cesarean deliveries, most notably wound complications, making this population even more susceptible to the morbidity associated with increased cesarean rates.…”

Section: Resultsmentioning

confidence: 99%

Spontaneous Labor Onset and Outcomes in Obese Women at Term

et al. 2017

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Objective The objective of this study was to compare the rates of spontaneous labor onset and its progression in obese and nonobese women after 37 weeks. Study Design We performed a secondary analysis of a retrospective cohort of all women who were admitted for delivery at ≥ 37 weeks of gestation at a university-based tertiary care center between 2004 and 2010. The cohort was stratified by weeks of gestation at which the patient presented for delivery. The rates of spontaneous labor, vaginal delivery, and augmentation with oxytocin were compared between obese (body mass index [BMI] ≥ 30) and nonobese (BMI < 30) women. Results Obese women had lower rates of spontaneous labor than nonobese women at every gestational week (37 weeks, 6.1 vs. 9.3%, p < 0.001; 38 weeks, 12.8 vs. 19.2%, p < 0.001; 39 weeks 26.0 vs. 37.0%, p < 0.001; 40 weeks, 39.6 vs. 50.2%, p < 0.001; 41 weeks, 30.8 vs. 38.0%, p < 0.012). Among women who presented in spontaneous labor, obesity was associated with higher rates of augmentation with oxytocin and lower rates of vaginal delivery. Conclusion Obese women at or beyond 37 weeks are less likely to experience spontaneous labor compared with nonobese women. In addition, obese women presenting in spontaneous labor are less likely that nonobese women to have a vaginal delivery at 37 to 40 weeks, even after oxytocin augmentation.

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Section: Resultsmentioning

confidence: 99%

Spontaneous Labor Onset and Outcomes in Obese Women at Term

et al. 2017

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“…Primarily, risk of eCS following failed IOL in nulliparous AMA women has never been revealed. Although previous studies have shown that maternal age is a considerable factor related to labor management, 6,12 a recent randomized controlled trial by Walker et al 18 showed conflicting results. In their study, women were randomly assigned to IOL or expectant management between 36 + 0 days and 39 + 6 days of gestation.…”

Section: Discussionmentioning

confidence: 98%

Factors associated with emergency cesarean delivery during induction of labor in nulliparous women aged 35 years or older at term

Nakano

Muto

Ishii

et al. 2018

J of Obstet and Gynaecol

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“…The mechanism responsible for the increased risk of intrauterine fetal death without structural defects in older women has not been explained so far. A meta-analysis of randomized trials has shown that induction of labor in women over 35 years of age is not associated with an increased risk of maternal or fetal complications and caesarean section [49,50]. Due to the risk of stillbirth in pregnant women of advanced reproductive age, it is recommended to treat pregnancies of women aged 40 and more as biologically mature at 39 weeks and consider the possibility of labor induction.…”

Section: Labor Induction In Pregnant Women Of Advanced Reproductive Agementioning

confidence: 99%