Clinical Edge

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Labor Induction in Low-Risk Nulliparous Women

N Engl J Med; 2018 Aug 9; Grobman, et al

In low-risk nulliparous women, induction of labor at 39 weeks did not result in a significantly lower frequency of a composite adverse perinatal outcome, but did result is a significantly lower frequency of cesarean delivery (CD). This according to a recent study that compared the perinatal and maternal consequences of induction of labor at 39 weeks among this population. Researchers randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to labor induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal complications. The secondary outcome was CD. Among the findings:

  • 3,062 women were assigned to labor induction; 3,044 were assigned to expectant management.
  • The primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group.
  • Frequency of CD was significantly lower in the induction group.

Citation:

Grobman WA, Rice MM, Reddy UM, et al. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med. 2018;379:513-523. doi:10.1056/NEJMoa1800566.