Low-risk pregnancy at 41 weeks: when should we induce labor?

Abstract

OBJECTIVE:

To study the perinatal outcome according to whether labor was induced or not, when a low-risk pregnancy reached 41 weeks of gestation.

METHODS:

A quasi-experimental study of 11492 low-risk singleton pregnancies was designed. A total of 1,721 patients (15.0%) women met the study criteria, were informed about the risks and benefits and gave their informed consent, of whom 629 (36.5%) were planned for induction soon after the 41 weeks (287-289 days).

RESULTS:

An intention-to-treat analysis was performed. The proportion of small-for-gestational age babies was lower in the early-induced labor cohort (10.5% versus 15%; p = 0.008). This cohort showed an increased hospital stay (4.54 versus 3.80 days; p < 0.001), and a higher rate of requiring delivery by caesarean section (31.1% versus 19.8%;p < 0.001), including the need for caesarean section for failed induction (21.8% versus 11%;p < 0.001). Three stillbirths occurred in the group followed expectantly, whereas no stillbirths were seen in the early induction group.

CONCLUSIONS:

Induction of labor for prolonged pregnancy in low-risk patients soon after the 41 weeks, reduces the proportion of small-for-gestational age babies, but increases the mean hospital stay as well as the need for delivery by caesarean section, including that for failed induction.

• Authors: Daniel Oros, María Pilar Bejarano, Manolo Romero Cardiel, Daniel Oros-Espinosa, Rafael Gonzalez de Agüero, Ernesto Fabre
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 25 Issue 6 Pg. 728-31 (Jun 2012) ISSN: 1476-4954 [Electronic] England
• PMID: 21827344 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Cohort Studies
• Female
• Gestational Age
• Humans
• Infant, Newborn
• Labor, Induced (statistics & numerical data)
• Male
• Pregnancy
• Pregnancy Complications (epidemiology, etiology)
• Pregnancy Outcome (epidemiology)
• Pregnancy, Prolonged (epidemiology, etiology, therapy)
• Risk
• Time Factors
• Young Adult