NEW YORK (Reuters Health) – Clinical outcomes are no better or worse when nulliparous women with an unfavorable cervix at term have elective induction of labor compared to those who are managed expectantly, reports a team at Northeastern University in Chicago, Illinois.
Elective induction is, however, associated with higher resource utilization, according to the report in Obstetrics & Gynecology for March.
Dr. Sarah Osmundson and colleagues note that in most previous studies of labor induction, it is indicated for medical reasons, so the outcomes cannot be generalized to elective induction. Furthermore, the selection of control groups has been problematic.
They therefore studied a cohort of nulliparous women with a Bishop cervix score less than 5, 102 of whom underwent elective induction of labor between 39 and 40 5/7 weeks and 102 who were managed expectantly beyond 39 weeks.
The main outcome was conversion to cesarean delivery. The c-section rate was 43.1% in the elective induction group and 34.3% in the expectant management group — not a statistically significant difference at a p value of 0.16.
Rates of meconium staining were lower with elective induction rather than expectant management (7.0% vs. 36.3%) but this did not affect health outcomes, the investigators report. There were no differences in maternal outcomes, and neonatal outcomes were statistically similar in both groups.
However, “Labor characteristics were significantly different between women who were electively induced and those who were expectantly managed,” the team found. Time spent in labor and delivery in the two groups was 16.5 hours vs. 12.7 hours, respectively.
“The findings of the present study should not be viewed as an endorsement of routine induction of labor. Induction of labor is associated with a greater utilization of labor and delivery resources with no clear maternal benefit,” Dr. Osmundson and colleagues conclude. “Rather, these findings should be used to highlight the need for an appropriately powered randomized trial of induction of labor.”
Reference:
Elective Induction Compared With Expectant Management in Nulliparous Women With an Unfavorable Cervix
Obstet Gynecol 2011;117:583-587.
