Inducing labor for women after 37 weeks of pregnancy can
help reduce the risk of perinatal mortality, i.e., death before, during or shortly
after birth, without increasing caesarean section rates.
However, induction is associated with a greater risk of
admission to a special care baby unit.
Induction of labor is frequently performed for pregnancies
of more than 41 weeks gestation to reduce perinatal mortality. Induction at
term (beyond 37 weeks) can also reduce complications, particularly when a mother
has existing health problems like high blood pressure.
Yet there has been no large study examining the risks and
benefits of induction at term on newborn deaths.
This information is needed to help guide decisions about
pregnancy management. So a team of researchers in Scotland compared rates of
perinatal mortality and maternal complications after elective induction
(induction of labor with no recognized medical indication) and expectant
management (continuation of pregnancy to either spontaneous labor or induction
or caesarean section at a later date).
Using Scottish birth and death records, they analyzed data
for over 1.2 million women with single pregnancies who gave birth after 37
weeks gestation between 1981 and 2007. Outcomes were adjusted for factors such
as age at delivery, whether the mother had given birth before, birth weight and
At each gestation between 37 and 41 weeks, elective
induction of labor was associated with lower death rates compared with
expectant management, without increasing the need for a caesarean section. For
example, at 40 weeks gestation, deaths occurred in 37 out of 44,764 (0.08%) in
the induction group compared with 627 out of 350,643 (0.18%) in the expectant
However, elective induction of labor was associated with
increased rates of admission to a special care baby unit (8%) compared with
expectant management (7.3%).
This means that for every 1,040 women having elective
induction of labor at 40 weeks, one newborn death may be prevented, but this
would result in seven more admissions to a special care baby unit, explain the
Although there's a possibility that some other unmeasured
(confounding) factor may explain these results, the authors conclude that
elective induction of labor at term "has the potential to reduce perinatal
mortality in developed countries without increasing the risk of operative