Elective labour induction at 39 weeks of gestation abates emergency CS, maternal and neonatal complications: JAMA
A systemic review and meta-analysis published in JAMA Network Open entitled, "Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management” has concluded that compared with expectant management, elective induction of labor at 39 weeks of gestation decreases the likelihood of labor-related complications, including a 37% reduced likelihood of third- or fourth-degree perineal injury.
They also mentioned that elective induction at 39 weeks increased the likelihood of shoulder dystocia among nulliparous women only.
Elective induction of labor at 39 weeks of gestation is common. There is an urgent need to assess complications related to maternal labor and neonatal outcomes associated with elective labour induction.
Researchers reviewed the literature using the MEDLINE, Embase, Cochrane Central Library, WHO, and ClinicalTrials.gov databases.
They measured Maternal outcomes (emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth)and Neonatal outcomes (admission to the neonatal ICU, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia).
The important points of this research study are summarised below:
- There were 14 studies with more than 1.6 million participants.
- The induction of labor at 39 weeks of gestation improved maternal labor-related and neonatal complications.
- There was a 37% reduced likelihood of third- or fourth-degree perineal injury and reductions in an operative vaginal birth, macrosomia and low 5-minute Apgar score.
- Among nulliparous women only, induction of labor increased the likelihood of shoulder dystocia than expectant management.
They concluded elective induction of labor at 39 weeks may be safe and beneficial for some women, but discussing the potential risks with nulliparous women is crucial.
They said, “To our knowledge, this is the largest systematic review and meta-analysis examining maternal and neonatal complications following elective induction of labor at 39 weeks of gestation than expectant management.”
We examined differences between induction of labor and expectant management more holistically, investigating important maternal and neonatal outcomes that may contribute to shared decision-making between clinicians and patients. We also demonstrated an essential difference between nulliparous and multiparous women. The results of the study should be applied in providing more personalized evidence to women considering induction of labor, they said.
The study's main limitations were a small number of observational studies and relevant randomized trials, classification biases, and misclassification.
Further reading:
Hong J, Atkinson J, Roddy Mitchell A, et al. Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(5):e2313162. doi:10.1001/jamanetworkopen.2023.13162
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