In the JournalsPerspective

Induced labor lowers risk of cesarean delivery

Women who underwent labor induction at 39 weeks gestation had a significantly reduced likelihood of a cesarean birth, as well as fewer maternal and newborn complications, according to research published in The New England Journal of Medicine.

“There’s a lot of controversy around the consequences of inducing labor. People were convinced that it increased the risk of cesarean delivery, but the reality was actually unknown,” William A. Grobman, MD, from the department of obstetrics and gynecology at Northwestern University, said in a press release.

Grobman and colleagues conducted a multicenter trial to compare the effects of induced labor and expectant management among low-risk nulliparous women. Participants were randomly assigned to receive either labor induction (n = 3,062) or expectant management (n = 3,044) at 39 weeks. Data on outcomes, including perinatal death, severe neonatal complications and cesarean delivery, were recorded.

The study revealed that more neonates in the expectant-management group experienced perinatal death and severe neonatal complications than those in the induction group (5.4% vs. 4.3%; RR = 0.8; 95% CI, 0.64-1). Cesarean delivery occurred significantly less often among women in the induction group compared with the expectant-management group (18.6% vs. 22.2%; RR = 0.84; 95% CI, 0.76-0.93).

Additionally, rates of preeclampsia and gestational hypertension were lower in the induction group than the expectant management group (9% vs. 14%). Rates of respiratory support among newborns was also lower in the induction group than the non-induction group (3% vs. 4%).

“This study provides evidence that inducing labor at 39 weeks actually reduces cesarean delivery,” Grobman said in the release.

“This new knowledge gives women the autonomy and ability to make more informed choices regarding their pregnancy that better fit with their wishes and beliefs,” he added. “Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when.” – by Alaina Tedesco

Disclosure: Grobman reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

Women who underwent labor induction at 39 weeks gestation had a significantly reduced likelihood of a cesarean birth, as well as fewer maternal and newborn complications, according to research published in The New England Journal of Medicine.

“There’s a lot of controversy around the consequences of inducing labor. People were convinced that it increased the risk of cesarean delivery, but the reality was actually unknown,” William A. Grobman, MD, from the department of obstetrics and gynecology at Northwestern University, said in a press release.

Grobman and colleagues conducted a multicenter trial to compare the effects of induced labor and expectant management among low-risk nulliparous women. Participants were randomly assigned to receive either labor induction (n = 3,062) or expectant management (n = 3,044) at 39 weeks. Data on outcomes, including perinatal death, severe neonatal complications and cesarean delivery, were recorded.

The study revealed that more neonates in the expectant-management group experienced perinatal death and severe neonatal complications than those in the induction group (5.4% vs. 4.3%; RR = 0.8; 95% CI, 0.64-1). Cesarean delivery occurred significantly less often among women in the induction group compared with the expectant-management group (18.6% vs. 22.2%; RR = 0.84; 95% CI, 0.76-0.93).

Additionally, rates of preeclampsia and gestational hypertension were lower in the induction group than the expectant management group (9% vs. 14%). Rates of respiratory support among newborns was also lower in the induction group than the non-induction group (3% vs. 4%).

“This study provides evidence that inducing labor at 39 weeks actually reduces cesarean delivery,” Grobman said in the release.

“This new knowledge gives women the autonomy and ability to make more informed choices regarding their pregnancy that better fit with their wishes and beliefs,” he added. “Induction at 39 weeks should not be routine for every woman, but it’s important to talk with their provider and decide if they want to be induced and when.” – by Alaina Tedesco

Disclosure: Grobman reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

    Perspective
    Alyssa Quimby

    Alyssa Quimby

    Elective induction of labor has been a hot topic since this study was first presented at the Society for Maternal Fetal Medicine’s annual meeting in February of this year. It is the first time we’ve seen a study of this magnitude on this topic which revealed somewhat surprising results. While neither the American College of Obstetricians and Gynecologists or the Society for Maternal-Fetal Medicine has altered their recommendations for elective induction, both organizations agree that this is an issue that deserves a closer look.

    What this means for practicing clinicians is that we now have up to date and compelling data supporting the benefits of induction at 39 weeks. We are now able to counsel patients that based on actual data (not anecdotal evidence), we do not increase the risk of cesarean section with elective induction after 39 weeks even in nulliparous women with an unfavorable Bishop score.

    In my practice, I have many patients interested in elective induction for a variety of reasons — mostly social — and these data have been quite helpful. I think it will be some time before we see any strong recommendations favoring elective induction coming from obstetric governing bodies, but with time, I believe this trend will change. After all, we all share the common goal of decreasing cesarean rates and increasing favorable obstetric outcomes — it’s just a question of how best to get there.     

    • Alyssa Quimby, MD
    • Assistant Professor of Clinical Obstetrics & Gynecology Keck School of Medicine University of Southern California

    Disclosures: Quimby reports no relevant financial disclosures.