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Inducing labour in late term pregnancies looks like the safer option for babies rather than taking a “wait and see” approach, according to a new study.
Results from a trial by Swedish researchers published in The BMJ found inducing labour at 41 weeks was associated with a lower risk of newborn babies dying compared with simply seeing how things went up to 42 weeks.
“Choice is important within maternity care”
Based on their findings they argue induction of labour should be offered to women no later than 41 weeks into pregnancy.
Clinicians generally agree there is an increased risk of problems – or adverse perinatal outcomes – for both mothers and babies at or beyond 42 weeks of pregnancy.
Some studies suggest induction at 41 weeks may be beneficial. However, there is no consensus on how best to manage healthy pregnancies lasting more than 41 weeks.
Current practice in the UK and Scandinavia is to induce delivery for all women who have not gone into labour by 42 weeks.
This latest study set out to compare the induction of labour at 41 weeks with “expectant management” – essentially a wait and see approach – until 42 weeks in low risk pregnancies.
The trial involved more than 2,700 women – who were 41 weeks pregnant – recruited from 14 Swedish hospitals between 2016 and 2018.
Participants were randomly assigned to induction of labour at 41 weeks or expectant management up to 42 weeks.
Researchers compared the two different approaches using a combined measure of babies’ health, which included stillbirth or death in the first few days of life, an Apgar score of less than 7 five minutes after birth, low oxygen levels and breathing problems.
Other outcomes such as admission to an intensive baby care unit, Apgar scores of less than 4 at five minutes, birth weight, pneumonia or sepsis, type of delivery and the mother’s health just after giving birth were also assessed.
They found pretty much no difference between the two groups with 2.4% of women in the induction group experiencing a perinatal adverse outcome compared with 2.2% in the expectant management group.
“Women with low risk pregnancies should be…offered induction of labour no later than 41 full weeks”
Other outcomes such as caesarean sections and mothers’ health did not differ between the two groups.
However, six babies in the expectant management group died – five stillbirths and one early neonatal death – compared with none in the induction group.
Researchers had planned to run the trial with more than 10,000 women but it was stopped early.
While factors such as differences in hospital policies and procedures could have affected the results, the researchers say their findings are significant.
They estimate that for every woman induced at 41 weeks, one perinatal death could be prevented.
“Women with low risk pregnancies should be informed of the risk profile of induction of labour versus expectant management and offered induction of labour no later than 41 full weeks,” said the paper.
In a linked article Sara Kenyon, professor of evidence-based maternity care at the University of Birmingham, and colleagues, said the new findings and evidence from previous trials suggested “induction at 41 weeks is a reasonable choice for women”.
“Choice is important within maternity care, and clear information about available options should be accessible to all pregnant women, enabling them to make fully informed and timely decisions,” they stressed.