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Labor Induction versus Expectant Management in Low-Risk Nulliparous Women

Citation

Grobman, William A.; Rice, Madeline M.; Reddy, Uma M.; Tita, Alan T.N.; Silver, Robert M.; Mallett, Gail; Hill, Kim; Thom, Elizabeth A.; El-Sayed, Yasser Y.; & Perez-Delboy, Annette, et al. (2018). Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. New England Journal of Medicine, 379(6), 513-523. PMCID: PMC6186292

Abstract

Background: The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain.
Methods: In this multicenter trial, we randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to labor induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal complications; the principal secondary outcome was cesarean delivery.
Results: A total of 3062 women were assigned to labor induction, and 3044 were assigned to expectant management. The primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group (relative risk, 0.80; 95% confidence interval [CI], 0.64 to 1.00). The frequency of cesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%; relative risk, 0.84; 95% CI, 0.76 to 0.93).
Conclusions: Induction of labor at 39 weeks in low-risk nulliparous women did not result in a significantly lower frequency of a composite adverse perinatal outcome, but it did result in a significantly lower frequency of cesarean delivery.

URL

http://dx.doi.org/10.1056/NEJMoa1800566

Reference Type

Journal Article

Article Type

Regular

Year Published

2018

Journal Title

New England Journal of Medicine

Author(s)

Grobman, William A.
Rice, Madeline M.
Reddy, Uma M.
Tita, Alan T.N.
Silver, Robert M.
Mallett, Gail
Hill, Kim
Thom, Elizabeth A.
El-Sayed, Yasser Y.
Perez-Delboy, Annette
Rouse, Dwight J.
Saade, George R.
Boggess, Kim A.
Chauhan, Suneet P.
Iams, Jay D.
Chien, Edward K.
Casey, Brian M.
Gibbs, Ronald S.
Srinivas, Sindhu K.
Swamy, Geeta K.
Simhan, Hyagriv N.
Macones, George A., for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network [
John M. Thorp Jr.,
member]

PMCID

PMC6186292

Continent/Country

United States of America