FPIN's Help Desk Answers
Risks of Elective Labor Induction vs. Expectant Management
Am Fam Physician. 2019 May 1;99(9):587-588.
Does elective labor induction at 39 weeks’ gestation increase maternal or fetal risks compared with expectant management?
Elective labor induction at 39 weeks’ gestation leads to a mean 145-g (5.1-oz) lower birth weight compared with expectant management, but there is conflicting evidence about the effects on rates of cesarean delivery, perinatal mortality, operative vaginal birth, and admission to the neonatal intensive care unit (NICU). Elective labor induction does not significantly change the risk of stillbirth, low Apgar score, or neonatal respiratory distress. (Strength of Recommendation [SOR]: A, based on a meta-analysis of randomized controlled trials [RCTs] and two cohort studies.) Elective labor induction is associated with a lower risk of postpartum hemorrhage, anal sphincter injury, and maternal third- or fourth-degree perineal lacerations. (SOR: B, based on two cohort studies.)
A 2012 meta-analysis (22 RCTs; N = 9,383) compared birth outcomes with elective labor induction vs. expectant management in uncomplicated, singleton pregnancies at term.1 Outcomes were subcategorized according to cervical favorability and gestational age, but parity was not distinguished. Primary outcomes included perinatal mortality, stillbirth, neonatal death, NICU admissions, Apgar scores, birth weight, cesarean delivery, and operative vaginal birth. Three of the RCTs (810 births) involved women at 39 to 40 weeks’ gestation. Pooled results showed that infants born after elective labor induction had lower mean birth weights than those born after expectant management (mean difference = –145 g; 95% CI, –248 to –42). There were no differences in any of the primary outcomes.
A 2013 retrospective cohort study (N = 362,154) compared elective labor induction with expectant management in women with vertex, singleton pregnancies delivering at 37 to 42 weeks’ gestation.2 Outcomes included rates of cesarean delivery, operative vaginal delivery, maternal
1. Gülmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. . Cochrane Database Syst Rev. . 2012;6:CD004945.
2. Darney BG, Snowden JM, Cheng YW, et al. Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes. Obstet Gynecol. 2013;122(4):761–769.
3. Stock SJ, Ferguson E, Duffy A, Ford I, Chalmers J, Norman JE. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ. 2012;344:e2838.
Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net).
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