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Inducing Labor at Term Appears to Reduce Cesarean Risk

Elective induction at 39 weeks also linked to lower risk of maternal high blood pressure disorders

WEDNESDAY, Aug. 8, 2018 (HealthDay News) — Inducing labor at 39 weeks may decrease the risk of cesarean section, according to a study published in the Aug. 9 issue of the New England Journal of Medicine.

William A. Grobman, M.D., from Northwestern University in Chicago, and colleagues randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to either labor induction at 39 weeks 0 days to 39 weeks 4 days (3,062 patients) or expectant management (3,044 patients).

The researchers identified a composite of perinatal death or severe neonatal complications in 4.3 percent of neonates in the induction group and 5.4 percent in the expectant-management group (relative risk, 0.80; 95 percent confidence interval, 0.64 to 1.00; P > 0.049). The induction group had a significantly lower frequency of cesarean delivery than the expectant-management group (18.6 versus 22.2 percent; relative risk, 0.84; 95 percent confidence interval, 0.76 to 0.93; P < 0.001). Women assigned to the induction group were also significantly less likely to have hypertensive disorders of pregnancy compared to women in the expectant-management group (9.1 versus 14.1 percent; relative risk, 0.64; 95 percent confidence interval, 0.56 to 0.74; P < 0.001).

“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 authors write. “The trial provides information that can be incorporated into discussions that rely on principles of shared decision making.”

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