Induction of labour beyond 37 weeks of pregnancy can reduce perinatal mortality without increasing caesarean section rates.
This is the finding of a study published on bmj.com. The same study found that induction did, however, increase the risk of admission to a special care baby unit.
A team of researchers in Scotland compared rates of perinatal mortality and maternal complications after elective induction and expectant management.
Using Scottish birth and death records, they analysed data for over 1.2 million women with single pregnancies who gave birth after 37 weeks gestation between 1981 and 2007. Outcomes were adjusted for factors such as age at delivery, whether the mother had given birth before, birth weight and deprivation.
At each gestation between 37 and 41 weeks, elective induction of labour was associated with lower death rates compared with expectant management, without increasing the need for a caesarean section. For example, at 40 weeks gestation, deaths occurred in 37 out of 44,764 (0.08%) in the induction group compared with 627 out of 350,643 (0.18%) in the expectant management group.
However, elective induction of labour was associated with increased rates of admission to a special care baby unit (8%) compared with expectant management (7.3%).
This means that for every 1,040 women having elective induction of labour at 40 weeks, one newborn death may be prevented, but this would result in seven more admissions to a special care baby unit, explain the authors.
Although there’s a possibility that some other unmeasured factor may explain these results, the authors conclude that elective induction of labour at term “has the potential to reduce perinatal mortality in developed countries without increasing the risk of operative delivery.”
Outcomes of elective induction of labour compared with expectant management: population based study. BMJ 2012;344:e2838 doi: 10.1136/bmj.e2838