BACKGROUND AND PURPOSE: 

• Data on nonmedically indicated induction in women ≥ 35 years compared to expectant management broken down by gestational weeks is limited  
• Kawakita et al. (American Journal of Perinatology, 2018) compared maternal and neonatal outcomes in women aged ≥ 35 years who had nonmedically indicated induction of labor (NMII) versus expectant management 

METHODS: 

• Retrospective cohort study  
• Participants: Nulliparous women with a singleton and cephalic presentation who delivered at term 
• Data derived from Consortium on Safe Labor (2002 and 2008) in 12 clinical centers/19 hospitals, supported by NICHD grant 
  • Data abstraction from medical records with rigorous data checking  
• Nonmedically indicated induction (NMII) 
  • No medical maternal/fetal disorder or PROM  
• Women were stratified into groups based on gestational week  
  • NMII at 37 weeks  
  • NMII at 38 weeks  
  • NMII at 39 weeks  
  • NMII at 40 weeks  
  • Those expectant management that week  
• Maternal and neonatal outcomes (individual and composite) were evaluated 
• Study not powered to assess rare adverse events such as stillbirth 

RESULTS: 

• 3819 women were included in the study 
  • 1409 (36.9%) women underwent NMII 
• No statistically differences in composite maternal outcomes at any gestational age  
• Overall, at 39 weeks’ gestation or later, maternal and neonatal outcomes were similar or improved with NMII 
• At 37, 38, and 39 weeks’ gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery  
  • 37 weeks:  adjusted odds ratio (aOR) 0.52; 95% CI, 0.31–0.88 
  • 38 weeks: aOR 0.64; 95% CI, 0.45–0.91 
  • 39 weeks: aOR 0.69; 95% CI, 0.53–0.91 
• At 40 weeks’ gestation, NMII compared with expectant management was associated with increased risk of operative vaginal delivery  
  • aOR, 2.43; 95% CI, 1.46–4.06  
• 40 weeks induction also associated with decreased odds of neonatal intensive care unit (NICU) admission 
  • aOR, 0.40; 95% CI, 0.20–0.81 

CONCLUSION: 

• Nonmedically indicated induction was correlated with decreased risk for cesarean delivery at 37 to 39 weeks gestation and at 40 weeks, with a decreased risk for NICU admission 

Learn More – Primary Sources: 

Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older 

Related ObG Topics:

A New Predictive Model for Successful Induction of Labor

Maternal Age: What is the Impact on Stillbirth and Other Adverse Pregnancy Outcomes?

Induction to Prevent Stillbirths for Age 35 and Older: Impact on Cesarean Rates?

Deliver Low Risk Patients at 39 Weeks to Prevent Hypertensive Complications?

Does Extending Pregnancy Beyond 39 weeks in Low-risk Pregnancies Incur Additional Risk?

The ARRIVE Trial and SMFM Guidance: Elective 39 Week Induction to Reduce the Risk of Cesarean Section