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.
NEJM: Randomized Trial of Labor Induction in Women 35 Years of Age or Older
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
