Birth complications could be reduced to a smaller extent if labor is induced at 41 weeks of pregnancy compared to the "wait and see" approach or otherwise known as expectant management until 42 weeks in low-risk women, reveals a clinical trial. The findings of the study are published in The BMJ.
However, the absolute risk of serious problems was low in both groups - and a linked editorial says the results are not sufficiently conclusive to change current practice, which is in line with the authors' interpretation.
Braxton Hicks Contractions
Braxton Hicks contractions, also called as prodromal labor or false labor pains are sporadic, unpredictable uterine contractions that mostly occur in late second trimester and in third trimester.
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‘Induction labor at 41 weeks resulted in an overall reduction in adverse perinatal outcome than expectant management.’
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Late term pregnancy (at or beyond 42 weeks) affects about 15% of women and is associated with increased problems at birth (known as adverse perinatal outcomes), including death.
Some studies suggest that inducing labor from 41 weeks onwards improves outcomes for both mother and baby, but these studies were different regarding their measures, protocols and time frames of comparison and so the results need to be interpreted with caution.
![Labor and Delivery / Pregnancy Labor]( "Labor and Delivery / Pregnancy Labor")
Childbirth is one of the most marvelous and memorable segment in a woman's life that calls for celebration. Knowledge about labor and delivery can ease unnecessary fear, ensuring a unique experience.
Yet despite these concerns, induction at 41 weeks is now an accepted policy in many countries throughout the world.
So researchers of the INDEX-team led by senior researcher Esteriek de Miranda at the Amsterdam UMC-University of Amsterdam, set out to compare induction of labor at 41 weeks with expectant management until 42 weeks in low risk pregnancies.
The trial included 1800 women (mainly white and younger than 35 years) with an uncomplicated pregnancy recruited from 123 midwifery practices and 45 hospitals in the Netherlands.
Women were randomized to either induction at 41 weeks or expectant management until 42 weeks with subsequent induction if necessary.
Adverse perinatal outcomes were assessed using a combined measure of the newborn's health (including perinatal death, Apgar score of less than 7 five minutes after birth, and admission to an intensive care baby unit). Other outcomes included type of delivery and mother's health just after giving birth.
Fifteen women (1.7%) in the induction group had an adverse perinatal outcome compared with 28 (3.1%) in the expectant management group - an absolute risk difference of 1.4% in favor of the induction group.
Eleven (1.2%) infants in the induction group and 23 (2.6%) in the expectant management group had an Apgar score of less than 7 out of 10 at five minutes.
No infants in the induction group and three (0.3%) in the expectant management group had an Apgar score of less than 4 out of 10 at five minutes.
One fetal death (0.1%) occurred in the induction group and two (0.2%) in the expectant management group. No neonatal deaths (deaths in the first 28 days of life) occurred.
Three (0.3%) infants in the induction group versus 8 (0.9%) in the expectant management group were admitted to an intensive care baby unit.
No significant differences in the mother's health or in cesarean section rates were found between groups.
The researchers point to some potential limitations, but say in this large trial induction of labor at 41 weeks resulted in less overall adverse perinatal outcome than a policy of expectant management until 42 weeks, although the absolute risk of severe adverse outcome was low in both groups.
As with every intervention in the natural birth process, the decision to induce labor must be made with caution, as the expected benefits should outweigh possible adverse effects for both mother and child, they add.
As such, they say their results "should be used to inform women approaching 41 weeks of pregnancy, so they can weigh the respective outcomes and decide whether to be induced at 41 weeks or to continue pregnancy until 42 weeks."
In a linked editorial, Professor Sara Kenyon at the University of Birmingham and colleagues welcome this new trial, but say the results "are not sufficiently conclusive to change current practice."
They point out that, if the Apgar scores are excluded, "the remaining data suggest little to choose between the two management options." And they warn that increasing induction rates (35% of women giving birth for the first time are currently induced in the UK) "may also impact negatively on women's birth experience."
Source: Eurekalert
Labor and Delivery / Pregnancy Labor
Childbirth is one of the most marvelous and memorable segment in a woman's life that calls for celebration. Knowledge about labor and delivery can ease unnecessary fear, ensuring a unique experience.
Advertisement
Yet despite these concerns, induction at 41 weeks is now an accepted policy in many countries throughout the world.
So researchers of the INDEX-team led by senior researcher Esteriek de Miranda at the Amsterdam UMC-University of Amsterdam, set out to compare induction of labor at 41 weeks with expectant management until 42 weeks in low risk pregnancies.
The trial included 1800 women (mainly white and younger than 35 years) with an uncomplicated pregnancy recruited from 123 midwifery practices and 45 hospitals in the Netherlands.
Women were randomized to either induction at 41 weeks or expectant management until 42 weeks with subsequent induction if necessary.
Adverse perinatal outcomes were assessed using a combined measure of the newborn's health (including perinatal death, Apgar score of less than 7 five minutes after birth, and admission to an intensive care baby unit). Other outcomes included type of delivery and mother's health just after giving birth.
Fifteen women (1.7%) in the induction group had an adverse perinatal outcome compared with 28 (3.1%) in the expectant management group - an absolute risk difference of 1.4% in favor of the induction group.
Eleven (1.2%) infants in the induction group and 23 (2.6%) in the expectant management group had an Apgar score of less than 7 out of 10 at five minutes.
No infants in the induction group and three (0.3%) in the expectant management group had an Apgar score of less than 4 out of 10 at five minutes.
One fetal death (0.1%) occurred in the induction group and two (0.2%) in the expectant management group. No neonatal deaths (deaths in the first 28 days of life) occurred.
Three (0.3%) infants in the induction group versus 8 (0.9%) in the expectant management group were admitted to an intensive care baby unit.
No significant differences in the mother's health or in cesarean section rates were found between groups.
The researchers point to some potential limitations, but say in this large trial induction of labor at 41 weeks resulted in less overall adverse perinatal outcome than a policy of expectant management until 42 weeks, although the absolute risk of severe adverse outcome was low in both groups.
As with every intervention in the natural birth process, the decision to induce labor must be made with caution, as the expected benefits should outweigh possible adverse effects for both mother and child, they add.
As such, they say their results "should be used to inform women approaching 41 weeks of pregnancy, so they can weigh the respective outcomes and decide whether to be induced at 41 weeks or to continue pregnancy until 42 weeks."
In a linked editorial, Professor Sara Kenyon at the University of Birmingham and colleagues welcome this new trial, but say the results "are not sufficiently conclusive to change current practice."
They point out that, if the Apgar scores are excluded, "the remaining data suggest little to choose between the two management options." And they warn that increasing induction rates (35% of women giving birth for the first time are currently induced in the UK) "may also impact negatively on women's birth experience."
Source: Eurekalert
Pain Management During Labor
The labor pain or pain of childbirth is considered as the one of the most severe types of pain. It was in the mid- nineteenth century the pharmacologic management of labor pain was introduced.
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