Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management

Abstract

ImportanceElective induction of labor at 39 weeks of gestation is common. Thus, there is a need to assess maternal labor-related complications and neonatal outcomes associated with elective induction of labor.ObjectiveTo examine maternal labor-related complications and neonatal outcomes following elective induction of labor at 39 weeks compared with expectant management.Data SourcesA systematic review of the literature was conducted using the MEDLINE (Ovid), Embase (Ovid), Cochrane Central Library, World Health Organization, and ClinicalTrials.gov databases and registries to search for articles published between database inception and December 8, 2022.Study SelectionThis systematic review and meta-analysis included randomized clinical trials, cohort studies, and cross-sectional studies reporting perinatal outcomes following induction of labor at 39 weeks vs expectant management.Data Extraction and SynthesisTwo reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Pooled odds ratios (ORs) and 95% CIs were calculated using a random-effects model. This study is reported per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline, and the protocol was prospectively registered with PROSPERO.Main Outcomes and MeasuresMaternal outcomes of interest included emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth. Neonatal outcomes of interest included admission to the neonatal intensive care unit, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia.ResultsOf the 5827 records identified in the search, 14 studies were eligible for inclusion in this review. These studies reported outcomes for 1 625 899 women birthing a singleton pregnancy. Induction of labor at 39 weeks of gestation was associated with a 37% reduced likelihood of third- or fourth-degree perineal injury (OR, 0.63 [95% CI, 0.49-0.81]), in addition to reductions in operative vaginal birth (OR, 0.87 [95% CI, 0.79-0.97]), macrosomia (OR, 0.66 [95% CI, 0.48-0.91]), and low 5-minute Apgar score (OR, 0.62 [95% CI, 0.40-0.96]). Results were similar when confined to multiparous women only, with the addition of a substantial reduction in the likelihood of emergency cesarean section (OR, 0.61 [95% CI, 0.38-0.98]) and no difference in operative vaginal birth (OR, 1.01 [95% CI, 0.84-1.21]). However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia (OR, 1.22 [95% CI, 1.02-1.46]) compared with expectant management.Conclusions and RelevanceIn this study, induction of labor at 39 weeks was associated with improved maternal labor-related and neonatal outcomes. However, among nulliparous women, induction of labor was associated with shoulder dystocia. These results suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.

Prediction of Failure to Progress after Labor Induction: A Multivariable Model Using Pelvic Ultrasound and Clinical Data

“…This would support previous research advocating for universal induction at 39 to improve the results of the perinatal outcome [23,24]. However, the decision should be agreed with the patient, since induction (especially in nulliparous women) also entails risks [23][24][25][26], such as shoulder dystocia [23].…”

Placental pathology and neonatal morbidity: exploring the impact of gestational age at birth

“…A systematic review found that inducing labour at 39 weeks was associated with improved neonatal outcomes in both in nulliparous and primiparous women. However, in nulliparous women, induction of labour was associated with shoulder dystocia [ 20 ]. The external validity of these studies [ 19 , 20 ] for the Norwegian practice is questionable since intervention rates during spontaneous and induced labour are substantially lower [ 21 , 22 ].…”

“…However, in nulliparous women, induction of labour was associated with shoulder dystocia [ 20 ]. The external validity of these studies [ 19 , 20 ] for the Norwegian practice is questionable since intervention rates during spontaneous and induced labour are substantially lower [ 21 , 22 ]. There is some evidence that induction of labour may reduce perinatal death and morbidity [ 23 ].…”

Elective Induction of Labor at 39 Weeks among Nulliparous Women at Mansoura University Hospital

“…When the hazards to the mother and unborn child of carrying a pregnancy to term exceed those of an accelerated delivery, IOL is advised. IOL may be necessary for post-term pregnancies that are older than 41 weeks, for medical conditions such as hypertension or pre-labor rupture of the membranes, or in situations where there may be inadequate fetal growth [8,9] . Induction without any medical indication is known as eIOL.…”