Routine Induction for Women 35 and Older – Are there Associated Risks?
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
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
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
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
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.
Disclosure of Unlabeled Use
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
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan