Induction of labour from 39 weeks in low‐risk multiparas with ripe cervixes: A randomised controlled trial

Abstract

Background Induction of labour (IOL) in low‐risk nulliparas at 39 weeks reduces caesarean delivery. Multiparas with ripe cervixes typically have vaginal delivery within eight hours. Delivery at night and weekend are associated with higher maternal and neonatal mortality. Aims To evaluate IOL in full‐term multiparas with ripe cervixes to achieve delivery at normal working hours and improve maternal satisfaction. Methods A randomised trial was performed in a tertiary hospital in Malaysia. Low‐risk multiparas with ripe cervixes (Bishop score ≥6) were recruited at 38+4–40+0 weeks, then randomised to planned labour induction at 39+0 weeks or expectant care. Primary outcomes were delivery during ‘normal working hours’ 09:00–17:00 hours, Monday–Friday and patient satisfaction by visual numerical rating scale. Results For IOL (n = 80) vs expectant care (n = 80) arms respectively, primary outcomes of delivery at normal working hours was 27/80 (34%) vs 29/78 (37%), relative risk (RR) 0.9, 95% CI 0.5–1.7, P = 0.41, patient satisfaction was 8.0 ± 1.8 vs 7.8 ± 1.6, P = 0.41; presentation for spontaneous labour or rupture of membranes were 27/80 (34%) vs 70/79 (89%), RR 0.4, 95% CI 0.3–0.5, P < 0.001; and for labour induction 52/80 (65%) vs 15/79 (19%), RR 3.4, 95% CI 2.1–5.5, P < 0.001. Caesarean delivery was 8/80 (10%) vs 4/79 (5%), RR 2.0, 95% CI 0.62–6.3, P = 0.25; and mean birthweight was 3.1 ± 0.3 vs 3.3 ± 0.4 kg, P = 0.06 for IOL vs expectant care, respectively. Conclusion Labour induction in low‐risk multiparas does not increase births during working hours or improve patient satisfaction. Antenatal clinic visits and non‐birth hospitalisation were significantly reduced.

Timing of induction of labour in the prevention of prolonged pregnancy: Systematic review with meta‐analysis

“…Twenty RCTs totalling 15 725 participants fulfilled our predefined criteria 19,20,[23][24][25][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and were included in this review. This includes an additional five RCTs (n = 1807 20,[23][24][25]34 ) compared to the NICE guideline. 11 Most studies compared induction to EM, where a maximum gestational age was specified for induction.…”

“…Included trials were published between 1975 and 2021. Funding was reported by seven RCTs 19,20,27,28,30,34,38 : all from universities and public funding bodies (nonpharmaceutical). Trials varied in size from 80 31 to 6103 19 participants.…”

“…Power calculations were reported by nine RCTs 19,20,[27][28][29]32,34,36,38 : five based on a "successful induction" (difference in caesarean birth, 32,34,38 vaginal delivery, 20 or spontaneous labour within 48 h 36 and four based on a difference in adverse perinatal outcomes. 19,[27][28][29] Comparisons Comparisons were grouped according to gestational age at planned induction.…”

“…Women with BMI < 30 [27][28][29]36,41 had greater benefit from earlier induction (perinatal death: four RCTs, n = 5108; NICU admission: five RCTs, n = 5810), whereas the higher BMI categories did not show evidence of an effect for the same outcomes. 19,20,28,32,34 This is reflected in the IPD analysis as both SWEPIS and INDEX were also categorised as BMI < 30. There was also a benefit (reduced caesarean: three RCTs, n = 6940) for mixed BMI (crossing 30) when we excluded one study 20 with BMI baseline imbalance.…”

“…19,20,28,32,34 This is reflected in the IPD analysis as both SWEPIS and INDEX were also categorised as BMI < 30. There was also a benefit (reduced caesarean: three RCTs, n = 6940) for mixed BMI (crossing 30) when we excluded one study 20 with BMI baseline imbalance. Only one RCT 28 reported BMI > 30.…”