Elective induction of labor versus expectant management at term among low-risk nulliparous pregnant women

A new study compared the cesarean section (CS) rate after elective induction of labor versus expectant management in low-risk nulliparous women – at 39 weeks gestation.

This was an open-label randomized controlled trial, conducted at a tertiary maternity care center. This study enrolled low-risk, first-time pregnant women at 38 to 38+4 weeks from 2019-2021. Participants were randomly assigned to two groups – the elective induction group (e-IOL) and the expectant management (EM) group, using computer-generated block randomization. The primary outcome was the CS rate; secondary outcomes included adverse maternal and perinatal results between the e-IOL and EM groups. An intention-to-treat analysis was performed.

Overall, 360 women participated in the study, with 179 in the e-IOL group and 180 in the EM group. Baseline demographic characteristics, including Bishop scores, were similar across the groups. The CS rate was 17.3% in the e-IOL group and 25% in the EM group, which was not statistically significant. There was one intrapartum stillbirth in the e-IOL group, while two neonatal deaths occurred in the EM group. There were no significant differences in maternal and perinatal outcomes between the groups.

The results showed that elective induction at 39 weeks in low-risk nulliparous women did not lead to a higher CS rate. Maternal and perinatal outcomes were comparable between the two groups. Further large, multicenter randomized controlled trials, especially from high-delivery-volume centers in emerging countries, are needed to fully understand the benefits of elective induction in this population.

Source: Lalithadevi P, Rengaraj S, Dasari P, et al. International Journal of Gynecology & Obstetrics. 2024 May 6.