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Elective Induction of Labor on Stillbirths 

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More Intervention Effect Estimate Summaries

Reference
Hussain AA, Yakoob MY, Imdad A, Bhutta ZA. Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis.  BMC Public Health 2011, 11(Suppl 3):S5.

Background

  • Prolonged gestation complicates 5-10% of all pregnancies and confers increased risk to both the fetus and mother. (1,2)
  • Post-term pregnancy is associated with higher rates of stillbirth, macrosomia (birth weight > 4000gm), birth injury and meconium aspiration syndrome. (2)
  • The intervention includes induction of labor versus expectant management defined here as the policy of awaiting spontaneous onset of labor

Intervention

Elective IOL for pregnancies > 41 weeks compared to expectant management on perinatal deaths

  • Significantly fewer perinatal deaths (RR-0.31; 95% CI 0.11-0.88) 
  • Moderate quality of evidence – based on 14 RCTs

Elective IOL for pregnancies > 41 weeks compared to expectant management on stillbirth

  • No significant difference in incidence of stillbirth (RR=0.29; CI 0.06-1.38) 
  • Moderate quality of evidence – based on 14 RCTs

Elective IOL for pregnancies > 41 weeks compared to expectant management on meconium aspiration

  • Significant decrease in incidence (57%) of neonatal morbidity from meconium aspiration (RR=0.43, 95% CI 0.23-0.79) 
  • Moderate quality of evidence – based on 7 RCTs

Elective IOL for pregnancies > 41 weeks compared to expectant management on macrosomia 

  • Significant decrease in incidence (28%) of neonatal morbidity from macrosomia (RR=0.72; 95% CI 0.54-0.98). 
  • Moderate quality of evidence – based on 7 RCTs

Elective IOL for pregnancies > 41 weeks compared to expectant management on birth asphyxia

  • Impact on birth asphyxia (RR=1.86%: CI 0.51-6.7) was not statistically significant. 
  • Moderate quality of evidence – based on 2 RCTs

Intervention Recommendation

  • Induction of labor is an effective way of reducing perinatal morbidity and mortality associated with post-term pregnancies.
  • Recommend using 69% reduction in perinatal mortality as the point estimate for the risk of stillbirth with IOL for prolonged gestation (>41 weeks).

References from Hussain Paper Cited Here

  1. Olesen AW, Westergaard JG, Olsen J: Perinatal and maternal complications related to postterm delivery: a national register-based study, 1978-1993. Am J Obstet Gynecol 2003, 189(1):222-227. 
  2. Norwitz ER, Snegovskikh VV, Caughey AB:  Prolonged pregnancy: when should we intervene?  Clin Obstet Gynecol 2007, 50(2): 547-557.

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