Document Type : Research Article
Introduction: The rate of maternal and perinatal complications increases after 39 weeks’ gestation. Growing body of evidence supports improved or not worsened birth outcomes with non-medically indicated induction of labor at 39 weeks gestation compared with expectant management. This evidence includes 2 recent randomized control trials.[2-4] This study was conducted to evaluate whether induction of labor at 39 weeks improves perinatal and maternal outcomes in women with low risk pregnancy compared with induction of labor at 40 + weeks.
Materials and Methods: This was a retrospective observational study in a rural teaching hospital in Mandya, Karnataka, India. The study population was 280 low risk women with an uncomplicated singleton pregnancy induced at 39 weeks (Group A, n=141) versus induction at 40 completed weeks of gestation (Group B, n=139). The data was retrieved from medical records department from January 2021 to April 2022. Mode of birth and other maternal and perinatal outcomes were described in each group, for women who underwent induction of labor at 39 weeks, and for women who gave birth from 40 completed weeks onward. The primary outcome included various modes of delivery. Secondary outcomes included maternal outcome and neonatal morbidity.
Results: In the current study, elective induction at 39 weeks gestation versus elective induction at 40 weeks gestation was compared. Induction at 39 weeks was associated with a decreased likelihood of cesarean birth (17.7% versus 23.7%) and a comparable increase in rate of operative vaginal birth (9.2% vs 10.7%)(p value<0.001). Indication for cesarean delivery in the majority of the study participants in Group A 44% was non-reassuring fetal status while in Group B 45.45% was secondary arrest of cervical dilatation (p value<0.001). An increased incidence of meconium stained amniotic fluid was noted in 19.4% among Group B participants compared to 14.1% in Group A (p value <0.001). In Group A 95.7% of the babies had an APGAR score of 7 at birth and in Group B 90.6% had an APGAR score of 7 at birth (p value <0.001). There was 1.4% neonatal NICU admission in Group A with 0.7% requiring respiratory support (p value<0.001). There was 5.03% neonatal NICU admission in Group B with 2.8% requiring respiratory support (p value<0.001). Term elective induction was associated with a statistically significant decrease in adverse newborn infant outcomes.
Conclusion: Elective induction of labor at 39 weeks gestation is associated with a decrease in cesarean birth and operative delivery and improved neonatal outcomes.