Labor Induction Reduces Cesarean Delivery Frequency for Low-Risk Women

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The relative risk was reduced by 20% for women with induced labor compared with women who underwent expectant management.
The relative risk was reduced by 20% for women with induced labor compared with women who underwent expectant management.

Labor induction in low-risk, nulliparous women does not significantly reduce negative perinatal outcomes but does significantly reduce the chances of cesarean delivery, according to a study published in The New England Journal of Medicine.

A team of investigators from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network conducted a multicenter study to determine the maternal and perinatal effects of labor induction at 39 weeks in low-risk, first-time expectant mothers.

The researchers invited women who were at 38 weeks to 38 weeks and 6 days of gestation to either expectant management or labor induction at 39 weeks to 39 weeks and 4 days.

The primary end point was combined perinatal death or severe neonatal adversities. The secondary end point was cesarean delivery.

Of the 6106 women included in the study, 3062 were randomly assigned to the labor-induction cohort, while 3044 were randomly assigned to the expectant-management cohort. In the labor-induction and expectant-management groups, primary end points were reported in 4.3% and 5.4% of neonates, respectively (relative risk, 0.80).

In addition, the investigators reported a significant reduction in cesarean delivery frequency among women in the labor-induction cohort (18.6%) compared with women in the expectant-management cohort (22.2%); the reported relative risk was 0.84.

“We found that elective labor induction at 39 weeks of gestation did not result in a greater frequency of perinatal adverse outcomes than expectant management and result in fewer instances of cesarean delivery,” the authors concluded. “These results suggest that policies aimed at the avoidance of elective labor induction among low-risk nulliparous women at 39 weeks of gestation are unlikely to reduce the rate of cesarean delivery on a population level; the trial provides information that can be incorporated into discussions that rely on principles of shared decision making.”

Reference

Grobman WA, Rice MM, Reddy UM, et al; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous woman. N Eng J Med. 2018; 379:513-523.

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