Induction of labour versus expectant management for well women and babies in pregnancies extending beyond 41 weeks: A systematic review and meta-analysis

Abstract

Background: Existing research concluding that there is increased perinatal mortality and morbidity when pregnancy extends beyond 42 weeks includes women and babies with known risks for increased mortality and morbidity. Objective(s): To investigate benefits and harms of a policy of induction of labour for well women and babies when pregnancy extends beyond 41 weeks. Design(s): Systematic review and meta-analysis. Method(s): We searched the Cochrane Central Register of Controlled Trials, CINAHL, Medline, Web of Science Core Collection and SCOPUS databases for randomised controlled trials published from 1996 to September 2017 comparing induction of labour from 41 weeks gestation with expectant management for women and babies with no known obstetric or medical risk factors. Studies were quality assessed by two reviewers and data extracted and analysed using Review Manager 5 software. Main Outcome Measure(s): Primary: perinatal mortality. Secondary: Apgar <7 at 5 min, cord gases (arterial and venous pH), meconium aspiration, admission to neonatal intensive care unit, neonatal convulsions, caesarean birth, forceps or vacuum assisted vaginal birth, breastfeeding at discharge, analgesia, severe perineal injury (3rd and 4th degree tears), postpartum haemorrhage, maternal satisfaction, postnatal depression. Result(s): Seven trials comprising 1068 women met the inclusion criteria of the review. Quality of included trials was judged to be weak. There was no statistically significant effect on perinatal mortality when induction was compared with expectant management (relative risk (RR) 0.33; 95% confidence interval (CI) 0.01-8.05). There were no significant differences between induction and expectant management in caesarean section, with almost equal numbers in groups (RR 0.98 95% CI 0.72-1.33), nor in other secondary outcomes. Conclusion(s): There was no improvement in outcomes associated with induction of labour compared to expectant management for well women and babies when their pregnancies extend beyond 41 weeks. Routine induction of labour from 41 weeks gestation for otherwise well women and babies exposes large numbers of women to a medical intervention not shown to improve outcomes.Copyright © 2018