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Am J Perinatol 2022; 39(05): 519-525
DOI: 10.1055/s-0040-1716711
Original Article

Labor Induction at 39 Weeks Compared with Expectant Management in Low-Risk Parous Women

Authors

  • Stephen M. Wagner 

    1   Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas

  • Grecio Sandoval

    2   George Washington University Biostatistics Center, Washington, District of Columbia

  • William A. Grobman

    3   Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

  • Jennifer L. Bailit

    4   MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio

  • Ronald J. Wapner

    5   Departments of Obstetrics and Gynecology, Columbia University, New York City, New York

  • Michael W. Varner

    6   Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah

  • John M. Thorp Jr.

    7   University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

  • Mona Prasad

    8   Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

  • Alan T. N. Tita

    9   Departments of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

  • George R. Saade

    10   University of Texas Medical Branch, Galveston, Texas

  • Yoram Sorokin

    11   Wayne State University, Detroit, Michigan

  • Dwight J. Rouse

    12   Brown University, Providence, Rhode Island

  • Jorge E. Tolosa

    13   Oregon Health & Science University, Portland, Oregon
    • for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network

Funding The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, and HD53118). The National Center for Research Resources (UL1 RR024989 and 5UL1 RR025764). Comments and views of the authors do not necessarily represent views of the National Institutes of Health.
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Abstract

Objective Our objective was to compare outcomes among low-risk parous women who underwent elective labor induction at 39 weeks versus expectant management.

Study Design This is a secondary analysis of an observational cohort of 115,502 mother–infant dyads who delivered at 25 hospitals between 2008 and 2011. The inclusion criteria for this analysis were low-risk parous women with nonanomalous singletons with at least one prior vaginal delivery after 20 weeks, who delivered at ≥390/7 weeks. Women who electively induced between 390/7 and 396/7 weeks were compared with women who expectantly managed ≥390/7 weeks. The primary outcome for this analysis was cesarean delivery. Secondary outcomes were composites of maternal adverse outcome and neonatal adverse outcome. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR).

Results Of 20,822 women who met inclusion criteria, 2,648 (12.7%) were electively induced at 39 weeks. Cesarean delivery was lower among women who underwent elective induction at 39 weeks than those who did not (2.4 vs. 4.6%, adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.53–0.92). The frequency of the composite maternal adverse outcome was significantly lower for the elective induction cohort as well (1.6 vs. 3.1%, aOR: 0.66, 95% CI: 0.47–0.93). The composite neonatal adverse outcome was not significantly different between the two groups (0.3 vs. 0.6%; aOR: 0.60, 95% CI: 0.29–1.23).

Conclusion In low-risk parous women, elective induction of labor at 39 weeks was associated with decreased odds of cesarean delivery and maternal morbidity, without an increase in neonatal adverse outcomes.

Key Points

  • 39-week elective induction is associated with decreased cesarean delivery in low-risk parous women.

  • Compared with expectant management, maternal adverse outcomes were lower with elective induction.

  • Neonatal adverse outcomes are unchanged between elective and expectant management groups.

Keywords

elective induction - parous pregnancy - cesarean delivery - maternal morbidity

Note

This study was presented in part at the 40th annual meeting of the Society for Maternal–Fetal Medicine, February 3 to 8, 2020, Grapevine, TX.


* See [Supplementary Material] (available in the online version) for the list of other members of the NICHD MFMU Network.


Supplementary Material



Publication History

Received: 30 June 2020

Accepted: 09 August 2020

Article published online:
11 September 2020

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