Journal
BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY
Volume 79, Issue -, Pages 107-125Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bpobgyn.2021.12.007
Keywords
Labour induction; Cervical ripening; 39 weeks of gestation; Low-risk pregnancies; Systematic review; Meta-analysis
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This systematic review suggests that induction of labor at 39-40 weeks for non-medical reasons does not reduce caesarean births or perinatal morbidity. However, it may be associated with a lower incidence of maternal hypertensive disorders, a shorter duration of labor, fewer instances of meconium-stained amniotic fluid, lower mean birth weights, longer duration of hospitalization, and higher epidural usage.
This systematic review of 16 randomized trials, which included 8796 pregnancies, did not demonstrate a reduction in caesarean births or perinatal morbidity from induction of labour (IoL) at 39-40 weeks for non-medical indications. However, IoL at 39-40 weeks may be associated with a lower incidence of maternal hypertensive disorders, a shorter duration of the first stage of labour, fewer instances of meconium-stained amniotic fluid, lower mean birth weights, longer duration of (maternal) hospitalization, and higher epidural usage. Until regional data on clinical benefits, resource implications and long-term impact are available, a prudent approach would be to encourage shared decision-making, wherein birthing persons with low-risk pregnancies are given the opportunity to assess the risks and benefits of IoL at 39-40 weeks over expectant management and allowed to consider their decision in the light of their values and preferences and local resource availability. (C) 2022 Elsevier Ltd. All rights reserved.
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