Abstract
Objective: To determine maternal and neonatal morbidity
associated with induction of labor at 39 weeks compared with expectant
management through 42 weeks.
Design : Cohort study
Setting & Population : Low risk American women who
delivered between 39 and 42 weeks in 2015 to 2017.
Methods: Data was abstracted from the national vital
statistics database. Multivariable log-binomial regression analysis was
conducted to estimate the relative risk of morbidity.
Main Outcome Measures : Maternal morbidity included
Triple I, blood transfusion, ICU admission, uterine rupture, cesarean
hysterectomy, and cesarean delivery. Neonatal morbidity included 5
minute Apgar ≤3, prolonged ventilation, seizures, NICU admission, and
neonatal death.
Results: A total of 1,885,694 women were included for
analysis. Women undergoing induction of labor at 39 weeks were less
likely to develop Triple I (p-value < 0.001; aRR 0.66; 95% CI
[0.64-0.68]) and require a cesarean section (p-value
<0.01; aRR 0.69l 95% CI [0.68-0.69]) than the expectant
management group. There was a small, but significant increase in
cesarean hysterectomy in the induction group (p-value <0.01;
aRR 1.32; 95% CI [1.05-1.65]). Neonates of the induction group were
less likely to have 5 minute Apgar ≤3 (p-value < 0.01; aRR
0.69; 95% CI [0.64-0.74]), prolonged ventilation (p-value
< 0.01; aRR 0.77; 95% CI [0.72-0.82]), NICU admission
(p-value < 0.01; aRR 0.80; 95% CI [0.79-0.82]), and/or
neonatal seizures (p-value <0.01; aRR 0.80; 95% CI
[0.66-0.98]) compared to the expectant management group.
Conclusions: Induction of labor at 39 weeks gestation
compared with expectant management is not harmful and has maternal and
neonatal benefits.
Tweetable abstract: Induction of labor at 39 weeks is
associated with both maternal and neonatal benefits.
Keyword s: Induction of labor, expectant management, 39
weeks gestation, maternal morbidity, neonatal morbidity