Induction of Labor and Cesarean Delivery

Grobman, W. A. New England Journal of Medicine 2016; 374:880-881. Published online: March 3, 2016

At the heart of obstetrical care is a seemingly simple calculus: when are the benefits of delivery greater than the benefits of continued pregnancy? However, making this determination is anything but straightforward, given the potentially conflicting needs of the mother and the needs of her offspring, which must both be taken into account to maximize maternal and perinatal health.

In the absence of maternal or fetal complications, current consensus favors the consideration of delivery between 41 weeks 0 days and 42 weeks 0 days of gestation. In addition, for these women, delivery is recommended after 42 weeks 0 days and no later than 42 weeks 6 days of gestation, given the increase in perinatal morbidity and mortality at these gestational ages.1 Thus, induction before 41 weeks 0 days of gestation in the absence of complications is considered not to be medically indicated.

One consideration that traditionally has tipped the balance toward continuing pregnancy is the concern that labor induction may increase the risk of cesarean delivery, particularly among nulliparous women. This belief is based on the findings of multiple observational studies in which outcomes in women who underwent induction were compared with those of women who had spontaneous labor.2 However, spontaneous labor is not a clinical “strategy,” and thus it is not the appropriate comparison.

Read the full editorial here




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