Induction of labour in low-risk pregnancies before 40 weeks of gestation: A systematic review and meta-analysis of randomized trials

Dong, Susan; Bapoo, Shakira; Shukla, Minakshi; Abbasi, Nimrah; Horn, Daphne; D’Souza, Rohan

doi:10.1016/j.bpobgyn.2021.12.007

Cited by 12 publications

(4 citation statements)

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“…The practice shift toward elective induction at 39 weeks of gestation has been largely driven by the ARRIVE trial, which demonstrated a decreased risk of emergency cesarean birth with induction compared with expectant management. 10 While subsequent meta-analyses have supported these findings, 11,35,36 others have shown no association between induction of labor and cesarean section rates. [37][38][39][40] Our findings are consistent with those of the ARRIVE trial, which demonstrated an 18% reduced likelihood of emergency cesarean section.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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 (&lt;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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…A recent study (Dong et al 2022) of 8796 full-term pregnancies examined the indications and main outcomes of induced labor in patients at 39/40 weeks of gestation. 5 The findings demonstrated that there was no increase in cesarean section rate or perinatal morbidity when labor was triggered at 39/40 weeks of amenorrhea for non-medical indications. 5 At the same time, inducing labor at the above-mentioned gestational age is associated with a lower incidence of maternal hypertensive complications during pregnancy, shorter duration of the first period of labor, fewer cases of meconium amniotic fluid during birth, lower mean birth weight, longer maternal hospitalization, and a higher rate of epidural usage.…”

Section: Resultsmentioning

confidence: 90%

“…5 At the same time, inducing labor at the above-mentioned gestational age is associated with a lower incidence of maternal hypertensive complications during pregnancy, shorter duration of the first period of labor, fewer cases of meconium amniotic fluid during birth, lower mean birth weight, longer maternal hospitalization, and a higher rate of epidural usage. 5 To assess the effectiveness of labor induction methods, Quach et al (2022) conducted a meta-analysis of 2990 patients based on the PROBAAT trials, in which they determined the maternal and fetal characteristics that influenced the cesarean section rate following induction of labor in patients with full-term, single-fetal pregnancy, intact membranes, cephalic presentation, and unfavorable cervix. 6 The authors developed mathematical models to determine the failure rate of induction of labor and conversion of birth to cesarean section.…”

Section: Resultsmentioning

confidence: 99%

Comparative analysis of pharmacologic and mechanical methods for labor induction in patients at full-term pregnancy—A systematic review

Juncu,

Vaso,

Cernețchi

et al. 2023

F1000Res

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Background Induction of labor is performed for either maternal or fetal indications to reduce perinatal morbidity and mortality without increasing maternal morbidity. The aim of this study was to review the scientific literature regarding induction of labor in patients with full-term pregnancy and create a systematic review of the literature to answer the question: “In patients with full-term gestation - does combining the Foley balloon with dinoprostone for the artificial induction of labor - offer better perinatal results over time from the application of the labor induction method until birth?”. Methods A literature search was performed on 23/08/2023 in the PubMed database; only articles published within the past 5 years were considered. We included articles in which labor was triggered with a vaginal device with dinoprostone, oxytocin, and/or a Foley catheter in full-term patients who met the following criteria: monofetal pregnancy, cranial presentation, intact membranes, and no history of uterine scar. We used the keywords “induction,” “labour,” “term,” “Foley,” “dinoproston,” “oxytocin.” Results The Pubmed database currently has approximately 20,000 scientific papers about labor induction. Only two studies met the proposed criteria. Considering the small volume of eligible data for the proposed research, the main meta-analysis addressing the topic was also considered. Conclusions The use of dinoprostone and oxytocin infusion is effective for triggering labor under conditions of compliance with obstetrical indications and pharmacological characteristics. Studies that compare the success of artificial induction of labor with Foley balloon and Foley+dinoprostone in patients with full term gestation are limited, but nevertheless, the association of Foley balloon with artificial induction with dinoprostone seems to be a cost-effective method. The limited number of scientific studies on this topic determines a risk of bias, inconsistency and imprecision, and for the future, we propose to carry out a randomized prospective study to study the topic.

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“…In a systematic review of ARRIVE (6106 women) 26 and 15 other trials (2690 women) of nulliparous women at term, labor induction (usually at 38-40 weeks), versus expectant care, reduced development of gestational hypertension or preeclampsia, with shorter first stages of labor and fewer babies with meconium-stained amniotic fluid, but without an impact on other perinatal outcomes or cesareans; however, timed birth was associated with more frequent use of epidural analgesia, longer maternal hospitalization, and lower birth weight. 27 There are no published trials of planned early term delivery in women at high risk of preeclampsia, based on NICE clinical criteria or the competing-risks model.…”

Section: Comparison With Literaturementioning

confidence: 99%

Preeclampsia Prevention by Timed Birth at Term

et al. 2023

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BACKGROUND: Most preeclampsia occurs at term. There are no effective preventative strategies. We aimed to identify the optimal preeclampsia screening and timing of birth strategy for prevention of term preeclampsia. METHODS: This secondary analysis was of data from a prospective nonintervention cohort study of singleton pregnancies delivering at ≥24 weeks, without major anomalies, at 2 United Kingdom maternity hospitals. At routine visits at 11 to 13 weeks’ (57 131 pregnancies screened, 1138 term preeclampsia developed) or 35 to 36 weeks’ gestation (29 035 pregnancies screened, 619 term preeclampsia), with patient-specific preeclampsia risks determined by: United Kingdom National Institute for Health and Care Excellence guidance, and the Fetal Medicine Foundation competing-risks model. For each screening strategy, timing of birth for term preeclampsia prevention was evaluated at gestational time points that were fixed (37, 38, 39, 40 weeks) or dependent on preeclampsia risk by the competing-risks model at 35 to 36 weeks. Main outcomes were proportion of term preeclampsia prevented, and number-needed-to-deliver to prevent one term preeclampsia case. RESULTS: The proportion of term preeclampsia prevented was the highest, and number-needed-to-deliver lowest, for preeclampsia screening at 35 to 36 (rather than 11–13) weeks. For delivery at 37 weeks, fewer cases of preeclampsia were prevented for National Institute for Health and Care Excellence (28.8%) than the competing-risks model (59.8%), and the number-needed-to-deliver was higher (16.4 versus 6.9, respectively). The risk-stratified approach (at 35–36 weeks) had similar preeclampsia prevention (by 57.2%) and number-needed-to-deliver (8.4), but fewer women would be induced at 37 weeks (1.2% versus 8.8%). CONCLUSIONS: Risk-stratified timing of birth at term may more than halve the risk of term preeclampsia.

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Induction of labour in low-risk pregnancies before 40 weeks of gestation: A systematic review and meta-analysis of randomized trials

Cited by 12 publications

References 54 publications

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

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

Comparative analysis of pharmacologic and mechanical methods for labor induction in patients at full-term pregnancy—A systematic review

Preeclampsia Prevention by Timed Birth at Term

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