Walker and colleagues designed their study (NEJM, 2016) to determine whether induction of labor to prevent stillbirth at term in primigravid women age 35 years or older increases the risk of cesarean section. 619 women were randomized to either induction at 39w0d and 39w6d of gestation or waiting for spontaneous onset of labor or induction for a medical indication. Monitoring in the control group was based on physician preference. Women could undergo induction between 41w0d and 42w0d. The researchers found:
There was no difference in the induction vs. control group for the following outcomes:
There is increased risk of adverse outcomes in women 35 years of age and older, including stillbirth at term. Cesarean section at 39 weeks could potentially be a preventative option. Women were not eligible for this study if they had complications such as a known lethal congenital anomaly, contraindications to labor, vaginal delivery or expectant management due to maternal medical complications such as gestational diabetes. Prior studies on the subject suggested increased risk of cesarean section as a result of induction, but were observational, not randomized.
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