Spontaneous Labor and Elective Induction—a Prospective Randomized Study

Abstract

In a prospective randomized study spontaneous and oxytocin induced labor "for convenience" have been compared with respect to uterine activity, duration of labor, the condition of the fetus and the newborn infant. The study consists of 84 normal patients, of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II; 41 patients served as controls. No difference in maternal age, number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups. The following parameters were calculated: duration of labor, uterine activity, amount of bleeding in the third stage of labor, number of early and late decelerations as well as number of episodes of bradycardia in the CTG-recordings, birth weight, Apgar score one and five minutes post-delivery and blood gases in mother and child 60 seconds after delivery. No significant differences between the two groups were found. It is concluded that there are no increased risks to mother or fetus compared to normal labor provided that there is cephalic presentation and normal pregnancy, careful selection with respect to the length of pregnancy and the condition of the cervix and that the Cardiff infusion system is used with intrauterine pressure recording and continuous fetal heart monitoring.

Elective Induction: When? Ever?

“…There have been few randomized trials that have compared elective labor induction with expectant management. [23][24][25][26][27][28] None of these trials have demonstrated differences between the groups with regard to outcomes such as cesarean delivery, operative vaginal delivery, or other maternal or perinatal morbidity. However, these trials were all relatively small, with the largest containing only 264 randomized women, and were correspondingly underpowered to detect differences even if they did exist.…”

Trends in Elective Labor Induction for Six United States Health Plans, 2001–2007

“…Few randomized trials have been conducted, all were small, [25][26][27][28][29][30] and most took place 20 or more years ago. [26][27][28]30 Given this lack of data, it is notable that in our cohort, the greatest decline in elective induction was seen for deliveries at 40 weeks-a group in which elective induction is not thought to be harmful. Initiatives to prevent early-term elective delivery may also decrease elective induction at 39 and 40 weeks, the clinical impact of which is not known.…”

Elective induction of labor: a prospective clinical study, II: Psychological effects

“…In his reviews, RICHARDS [17,18] warns against possible negative effects on the mother-infant relationship due to some complications of induction of labor such as cesarean section, forceps delivery, high doses of analgesics, prematurity and neonatal hyperbilirubinemia, but he does not mention a single study in which such effects on mother-infant interaction of elective induction of labor were directly demonstrated. Although a number of reports indicate that forceps delivery and repeat administration of analgesia occur more frequently in induced than in spontaneous labor [3,9,21,22,23,24], two studies including more than 2000 patients each [2,5] do not demonstrate early motherinfant separation as an important negative psychological sequela of induction of labor. On the other hand KITZINGER [11] found more cases of mother-infant separation after induction of labor in a highly selective patient population.…”

“…The shorter duration of labor when induced does not seem to be very important to parturient women [12]. Electronic fetal monitoring, which is almost always used in induced but not m spontaneous labor, usually appears to enhance feelings of safety, but sometimes feelings of discomfort are reported [7,10,20,21]. More favorable results are reported with telemetnc fetal monitoring [4,8].…”