The Positive and Negative of Elective Inductions

Elective induction of labor between 37 and 41 weeks of gestation can lower perinatal mortality rates in developed countries without increasing the risk of cesarean deliveries, according to a new study conducted in Scotland.1 According to the study authors, this is the first study that has quantified the benefits of labor induction in terms of a reduction in perinatal mortality.¹

In a retrospective cohort study, data from nearly 1.3 million women who gave birth between 1981 and 2007 were used to compare the outcomes of elective induction of labor with the outcomes of expectant management-continuation of pregnancy to either spontaneous labor or induced labor or cesarean delivery at a later date. At 40 weeks of gestation, infant death occurring at birth to 1 month of age occurred in 37 (0.08%) of 44,764 births in the elective induction group, compared with 627 (0.18%) of 350,643 births in the expectant management group.1 In addition, infants born after an elective induction were more likely to be admitted to the neonatal ICU than those born after expectant management (8% vs 7.3%, respectively). To simplify, the authors suggest that for every 1040 women who elect to induce labor at 40 weeks, 1 death of a newborn would be prevented.¹

The study authors do acknowledge that their finding that elective inductions are not strongly associated with increased odds of cesarean delivery goes against current obstetric dogma. One expert (James Ducey, MD, director of Meternal Fetal Medicine at Staten Island University Hospital in New York), who is skeptical of this finding, believes that “the best predictor of whether or not an induction of labor will result in an operative delivery is the status of the cervix when the induction is begun. This was not looked at in this study. It is highly likely that labor was induced electively only in those women whose cervixes were favorable."²

Pertinent Points:

- Elective induction of labor between 37 and 41 weeks of gestation was associated with a reduction in perinatal mortality and an increase in rates of admission to a neonatal ICU.
- No association between elective inductions and a reduction in rates of spontaneous vertex deliveries was found.

References:

References
1. Stock SJ, Ferguson E, Duffy A, et al. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ. 2012;344:e2838.
2. Preidt R. Induced labor late in pregnancy has pros, cons. Accessed May 22, 2012.