Induced Labor Late in Pregnancy Has Pros, Cons

Study found strategy could cut infant deaths, but raise number of babies requiring intensive care

By Robert Preidt

Thursday, May 10, 2012

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Childbirth

THURSDAY, May 10 (HealthDay News) -- Inducing labor after a woman has been pregnant for more than 37 weeks can reduce an infant's risk of death before, during or shortly after birth without increasing the need for cesarean delivery, a new study says.

However, babies born after induced labor were also more likely to require admission to a hospital's infant intensive care unit, said researchers led by Sarah Stock of the School of Women and Infant's Health at University of Western Australia.

One expert not connected to the study called it "an important article."

The work "confirms a prior retrospective study demonstrating that induction of labor is not associated with an increase in cesarean section," said Dr. Joanne Stone, a professor of obstetrics, gynecology and reproductive science at Mount Sinai School of Medicine in New York City.

"In addition, while there is a small increase in NICU [neonatal intensive care unit] admission, the prevention of fetal/neonatal death is an extremely important finding," she said.

The study involved data on more than 1.2 million women in Scotland who gave birth to a single baby after 37 weeks of gestation (40 weeks is considered full term).

Stock and colleagues found that induction of labor between 37 and 41 weeks' gestation was associated with a lower risk of death for infants, compared with "expectant management," which is the continuation of pregnancy until either natural birth or a C-section.

For example, at 40 weeks' gestation, deaths occurred in 37 of almost 45,000 deliveries (0.08 percent) in the induction group and in 627 of almost 351,000 cases (0.18 percent) in the expectant management group.
Induced labor did not increase the need for C-section, but infants born after induced labor had higher rates of admission to a special care baby unit than those born after expectant management -- 8 percent versus 7.3 percent.

According to the authors, these findings mean that for every 1,040 women who undergo induced labor at 40 weeks, one newborn death would be prevented. However, there would also be seven extra admissions to an intensive care baby unit.

Not everyone agreed with the study conclusions, however.

"The authors' conclusion that elective induction of labor at term has the potential to reduce perinatal mortality in developed countries without increasing the risk of operative delivery is probably not true," said Dr. James Ducey, director of Maternal Fetal Medicine at Staten Island University Hospital in New York City.

He 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 (opening of the womb) 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 cervices were favorable."

The study was published online May 10 in the BMJ.

SOURCES: Joanne Stone, M.D., professor, obstetrics, gynecology and reproductive science, Mount Sinai School of Medicine, New York City; James Ducey, M.D., director, Maternal Fetal Medicine, Staten Island University Hospital, New York City; BMJ, news release, May 10, 2012

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