Routine early induction in healthy women not supported by evidence

A systematic review has looked at the effects of early induction of labour on the mother and baby and concluded that induction prior to post-term is associated with few beneficial outcomes and several adverse outcomes.

The authors, Rydahl et al (2018), explain that the current shift towards earlier induction of labour which is occurring in many areas of the world “may lead to 15–20% more inductions. Given the fact that induction as an intervention can cause harm to both mother and child, it is essential to ensure that the benefits of the change in clinical practice outweigh the harms.” (Rydahl et al 2018).

The review, which focused on outcomes for healthy women, shows that there is cause for concern, however. Induction before post-term was found to be associated with an increased risk of caesarean section, chorioamnionitis, labour dystocia, precipitate labour and uterine rupture. There was a decreased risk of oligohydramnios and meconium stained amniotic fluid.

The authors conclude that, “Induction prior to post-term was associated with few beneficial outcomes and several adverse outcomes. This draws attention to possible iatrogenic effects affecting large numbers of low-risk women in contemporary maternity care. According to The World Health Organization, expected benefits from a medical intervention must outweigh potential harms. Hence, our results do not support the widespread use of routine induction prior to post-term (41+0–6 gestational weeks).” 

Their paper adds to growing concerns about the effects of induction of labour on the health of women and babies.

 

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Rydahl, E, Eriksen, L, Juhl, M (2018). Effects of induction of labor prior to post-term in low-risk pregnancies: a systematic review. JBI Database of Systematic Reviews and Implementation Reports doi: 10.11124/JBISRIR-2017-003587

 

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3 comments for “Routine early induction in healthy women not supported by evidence

  1. Tanya Burchell
    April 16, 2019 at 5:57 am

    Hi Sara, I am writing Maternity Guidelines for where I am living in India. I have read your Inducing Labour book and just been on your Gathering in the Knowledge, 2019 course. I love Sophie’s Ageing the Placenta blog that you referred to. I have included the statistics from your book, p74 about the risk of stillbirth at different gestations. Sophie refers to another paper with statistics for gestation and has different statistics. Yet, I cannot understand how she worked out those statistics from the paper. The paper is: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719843/ and she writes “I feel I need to explain first that the risk of increased stillbirth at term, which is the main reason behind induction policy, is actually very small, rising from about 0.1% (1 in a 1000) at 40-41 weeks, to about 0.3% (3 in a 1000) at 42 weeks and about 0.5% (5 in a 1000) at 43 weeks (from this paper).” Can you help me please? Am I missing something simple? I cannot see that the paper even mentions 43 weeks. I would ask Sophie but she isn’t replying to the comments on her blog. This whole subject is so emotive and controvercial!!! My brain is boggling and screaming with all of the contradictory beliefs, evidence, practices and opinions. It’s difficult to know what/how I should write guidlines for this subject!!!! Thank you for your inspiration, trawling through the research and giving it back to us in bite-sized pieces! Tanya!

  2. Tanya Burchell
    April 16, 2019 at 6:25 am

    Sara, I am also getting some abuse online for stating that research has shown that 42 weeks is less risky than 38 weeks! 🙁

  3. Tanya Burchell
    April 16, 2019 at 6:51 am

    OK, I take it back, I see where it says 43 weeks but I still can’t see how she got 5 in a 1000, etc.! Your book and the research paoer says 1 in 633.

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