Am J Obstet Gynecol MFM. 2024 Aug 14:101456. doi: 10.1016/j.ajogmf.2024.101456. Online ahead of print.
ABSTRACT
BACKGROUND: Growing evidence suggests that elective induction of labor at 39 weeks may lead to more favorable perinatal outcomes compared with the expectant management, however, how to weigh the pros and cons of elective labor induction at 39 weeks, the expectation of spontaneous delivery at 40 or 41 weeks, or delayed labor induction at 40 or 41 weeks on neonatal and maternal outcomes remains a practical challenge in clinical decision-making.
OBJECTIVE: We compared neonatal and maternal outcomes between elective induction of labor at 39 weeks and expectant management in a real word setting. We also divided the expectantly managed group and compared outcomes between the spontaneous delivery group at 40 or 41 weeks, and the induced group at 40 or 41 weeks versus the elective induced group at 39 weeks.
STUDY DESIGN: This retrospective cohort study included 21282 participants between January 1, 2019, and June 30, 2022. Participants were initially categorized into three groups at 39 weeks: elective induction of labor, spontaneous delivery, and expectant management, for the primary analysis comparing elective induction with expectant management. Subsequently, the expectant management group at 39 weeks was similarly divided into three groups at 40 weeks, and participants who underwent expectant management at 40 weeks were then divided into two groups at 41 weeks: elective induction and spontaneous delivery. In total, six groups were compared in the secondary analysis, with elective induction at 39 weeks serving as the reference group.
RESULTS: At 39 weeks’ gestational age, participants who received elective induction of labor had a significantly lower risk of primary composite outcomes compared to participants who received expectant management (adjusted odds ratio [aOR]: 0.72, 95% confidence interval [CI]: 0.55-0.95), and there was no significant difference in risk of cesarean delivery between the two groups. After further dividing the expectantly managed group, compared to participants with elective induction of labor at 39 weeks, those with spontaneous delivery at 40 weeks had significant lower risks of cesarean delivery (0.61, 0.52-0.71) and chorioamnionitis (0.78, 0.61-1.00), but a higher risk of fetal distress (1.39, 1.22-1.57); those with spontaneous delivery at 41 weeks had a significant higher risk of fetal distress (1.44, 1.16-1.79), postpartum hemorrhage (1.83, 1.26-2.66), and prolonged/arrested labor (1.61, 1.02-2.54). Moreover, compared to participants with elective induction of labor at 39 weeks, participants induced at later weeks had significantly higher risks of neonatal and maternal outcomes, especially at 40 weeks.
CONCLUSIONS: Our findings indicate that elective induction of labor at 39 weeks was significantly associated with lower risks of short-term neonatal and maternal outcomes compared to expectant management. Moreover, our study highlights the nuanced trade-offs in risks and benefits between elective induction at 39 weeks versus waiting for spontaneous labor or delayed induction at 40/41 weeks, thus providing valuable insights for clinical decision-making in practice.
PMID:39151749 | DOI:10.1016/j.ajogmf.2024.101456
