Clinical question
How beneficial is induction of labour at or beyond term compared with awaiting spontaneous labour or until an indication for induction of labour is identified on pregnancy outcomes for infant and mother?
Bottom line
A policy of labour induction at or beyond term compared with expectant management is associated with fewer perinatal deaths (number needed to treat to benefit = 426) and fewer caesarean sections, but more operative vaginal births. Neonatal intensive care unit admissions are lower and fewer babies have low Apgar scores with induction. No important differences are seen for most of the other maternal and infant outcomes.
Caveat
Most of the important outcomes assessed using GRADE tables had a rating of moderate or low-quality evidence. None of the trials provided information on breastfeeding at discharge from hospital, postnatal depression or whether the babies had encephalopathy, or on child development.
Context
Beyond term, the risks of stillbirth or neonatal death increase. It is unclear whether a policy of labour induction can reduce these risks.
Cochrane Systematic Review
Middleton P et al. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Reviews, 2018, Issue 5. Art. No.: CD004945.DOI: 10.1002/14651858. CD004945.pub4. This review contains 30 studies involving 12,479 participants.
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