Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study

Ravelli, Anita C.J.; Post, Joris A. M. van der; Groot, Christianne J.M. de; Abu‐Hanna, Ameen; Eskes, Martine

doi:10.1111/aogs.14536

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…In addition, induction of labor increased the rate of APGAR 5 min <7 in the first group. This is concordant with other published data (10,28) but also in contrast to other studies (14,15,19,21). In contrast, the rate of meconiumstained amniotic fluid or pH-value of the umbilical cord artery remained unaffected due to labor induction.…”

Section: Discussionsupporting

confidence: 92%

“…Analysis of delivery mode depending on obstetric management indicated that induction of labor enhanced the rate of secondary c-section and significantly decreased the rate of spontaneous deliveries while the rate of assistant vaginal deliveries remained unaffected. This is in line with some other studies, showing increased c-section rate subsequent to induction of labor beyond term (10,21,22,28,30,31). However, published data remain controversial, since other published studies report unchanged rate of c-section due to labor induction (14,15,20,26,27,(32)(33)(34).…”

Section: Discussionsupporting

confidence: 88%

“…With respect to different recommendations of current national guidelines depending on the gestational age (26), we analyzed the data within the subgroups 40+0-40+6 weeks, 40+7-40+10 weeks and >40+10 weeks. This classification is also in line with prior national retrospective studies (2, 27) and similar to other international studies (10,12,13,28). The strength of our study is the large number of singleton low-risk pregnancies beyond term which corresponds to a usual cohort in a university perinatal center.…”

Section: Discussionsupporting

confidence: 87%

“…section) rate following the induction of labor (18,19). However, other studies have shown no benefit for induction of labor regarding perinatal mortality (5,19,20), whereas others have reported increased c-section rate (10,21,22). Since most of these studies are retrospective and status of included patients as low-risk-pregnancies is debatable, current international guidelines are still discussed and differentially implemented in the respective countries.…”

Section: Maternal and Perinatal Outcome After Induction Of Labor Vers...mentioning

confidence: 99%

“…Furthermore, there is evidence for strong increase of perinatal mortality in postterm pregnancies (6,7). However, retrospective data indicate that risk of perinatal morbidity and mortality does not appear rapidly but develops continuously from the 39 th gestational week (6,(8)(9)(10)(11)(12)(13). Therefore, taking into account additional data from randomized clinical trials (14,15), several national guidelines implemented recommendations for induction of labor at 41 weeks or even support induction of labor at or beyond 37 gestational weeks (16,17).…”

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confidence: 99%

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Maternal and Perinatal Outcome After Induction of LaborVersusExpectant Management in Low-risk Pregnancies Beyond Term

PFLEIDERER,

GILMAN,

GRÜTTNER

et al. 2023

In Vivo

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Background/Aim: Due to still controversial discussion regarding appropriate termination of low-risk singleton pregnancies beyond term, this retrospective study aimed to evaluate maternal and perinatal outcomes depending on gestational age and obstetric management. Patients and Methods: This is a retrospective cohort analysis including 3.242 low-risk singleton deliveries at the Department of Obstetrics of the University Hospital of Cologne between 2017 and 2022. According to current national guidelines, the cohort was subdivided into three gestational groups, group 1: 40+0-40+6 weeks, group 2: 40+7-40+10 weeks and group 3>40+10 weeks. Results: In our cohort, advanced gestational age was associated with higher rates of secondary caesarean sections, lower rates of spontaneous vaginal deliveries, higher rates of meconium-stained amniotic fluid and depressed neonates with APGAR < 7 after 5 min. Analyzing obstetric management, induction of labor significantly increased the rate of secondary sections and reduced the rate of spontaneous deliveries, while the percentage of assistant vaginal deliveries was independent from obstetric management and gestational age. Induction of labor also significantly enhanced the need for tocolytic subpartu and epidural anesthesia and caused higher rates of abnormalities in cardiotocography (CTG), which also resulted in more frequent fetal scalp blood testing; however, the rate of fetal acidosis was independent of both obstetric management and gestational age. Conclusion: Our study supports expectant management of low-risk pregnancies beyond term, as induction of labor increased the rate of secondary sections and did not improve perinatal outcome.

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