Do Labor Inductions at Term Improve Chances for a Vaginal Delivery?


Is labor induction or expectant management better in term or post-term pregnancies? The findings from a new meta-analysis offer some insight.

Inducing labor lowers the risk of cesarean delivery in term and post-term gestations, a review of 157 clinical trials revealed.

A meta-analysis indicated the overall risk of cesarean delivery was 12% lower with labor induction than with expectant management (pooled relative risk [RR], 0.88; 95% confidence interval [CI], 0.84–0.93; I2 = 0%). However, the effect was not seen in preterm gestations. 

Pertinent Points

- Inducing labor reduces the risk of cesarean delivery by 12% in term and post-term gestations.

- Labor induction also lowered the risk of fetal death and admission to a neonatal intensive care unit.

- However, the practice did not have an impact on maternal death.

In addition, the researchers found that induced labor was associated with a 50% reduction in the risk of fetal death (RR, 0.50; 95% CI, 0.25–0.99; I2 = 0%) and a 14% reduction in admission to a neonatal intensive care unit (RR, 0.86; 95% CI, 0.79–0.94). Finally, inducing labor did not have an impact on maternal death (RR 1.00, 95% CI 0.10–9.57; I2 = 0%).

The findings, published in the Canadian Medical Association Journal, came from a review of randomized controlled trials that included a combined 31,085 deliveries. The results only apply to inductions using prostaglandin E2, the authors noted. The use of oxytocin and amniotomy did not show a decreased risk of cesarean delivery.

"The risk of cesarean delivery following labour induction was significantly lower than the risk associated with expectant management," the authors wrote. "This finding supports evidence from systematic reviews but is contrary to prevalent beliefs and information from consumer organizations, guidelines and textbooks."

The authors suggested that the findings could propel the use of induction as a way to increase the likelihood of a vaginal birth.

"Our meta-analysis has provided a robust answer to the disputed question of risk of cesarean delivery associated with induction of labour,” the authors concluded.

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