Induction of labour before 41 weeks or expectant management until 42 weeks: data from observational studies, randomized trials, systematic reviews and meta-analysis

• Oleg R. Baev
• Igor I. Baranov

Abstract

Timely induction of labor (IOL) is necessary and justified to prevent adverse maternal and fetal outcomes. The risk of stillbirth and some other serious perinatal and maternal complications increases as the pregnancy is delayed beyond a certain period.

Analysis of retrospective studies has shown that induction of labor at 39 to 41 weeks of gestation can reduce the frequency of caesarean section without worsening perinatal outcomes. In the conducted domestic prospective study, it was shown that IOL is more effective in gestational age up to 41 weeks (284-285 days) than in the period of more than 41 weeks (287 days or more), since less often there is no effect from preparation of the uterine cervix; less often there is a prolonged labor and necessity for appointment of oxytocin for medication correction of its state; the time between rupture and delivery is shorter; children with symptoms of postmaturity are less likely to be born; the frequency of cesarean section is lower.

The aim of the cited meta-analysis was to compare effect of IOL tactics at 41 weeks and expectant management until 42 weeks on adverse perinatal and maternal outcomes in women with low-risk singleton pregnancies, as well as to identify subgroups of women for whom IOL at 41 weeks could be the preferred option. The study included a review of 3 RCTs that enrolled a total of 5161 women with low-risk singleton pregnancies and compared IOL at 41 weeks of gestation with expectant management up to 42 weeks. Data from 2 RCTs (n=4561) met the eligibility criteria for inclusion in the meta-analysis.

Overall, induction of labor at 41 weeks of gestation significantly reduced the risk of adverse outcomes, including perinatal mortality and severe neonatal complications, without increasing the risk of caesarean section, operative vaginal delivery, third and fourth degree perineal tear, and postpartum hemorrhage. Data analysis results for pre-selected subgroups showed that risk of a cumulative rate of severe adverse perinatal outcomes is significantly lower in nulliparous women.

Keywords:preparing cervix for labor, labor induction, induction of labor

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