- Induction of labour in women with intact membranes reduces the risk of caesarean section.
Per a systematic review and meta-analysis of trials in women with intact membranes in 2014 by Wood S et.al. for the question 'Does induction of labour increase the risk of caesarean section?', the authors conclude that in clinical trials of induction of labour versus expectant management in women with intact nonruptured membranes, induction reduced the risk of caesarean section.
AUTHOR'S CONCLUSIONS: Induction of labour in women with intact membranes reduces the risk of caesarean section. Review of the trials suggests that this effect may arise from non-treatment effects, and that additional trials are needed.
- The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term.
Per a systematic review and meta-analysis of trials in women by Ekaterina Mishanina et.al. in 2014 to investigate whether the risk of cesarean delivery is higher or lower following labour induction compared with expectant management, the interpretations were
Interpretation: The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations. There were benefits for the fetus and no increased risk of maternal death.
- Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management.
Per Blair G. Darney et.al. in 2013, the results were "Elective induction was not associated with increased odds of severe lacerations, operative vaginal delivery, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, or macrosomia at any term gestational age."
CONCLUSION: Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management.
Per AB Caughey in 2014, "there are a few cautionary items to review before we start inducing all patients at 39 weeks of gestation".
First, the prospective studies of induction of labour included in the meta-analyses are generally from academic medical centres. It may be that the practice patterns in academic centres are different from those in the private-practice setting.
Additionally, there has been no large modern trial of induction versus expectant management at 39 or 40 weeks of gestation, i.e. the equivalent of the Hannah trial of induction versus expectant management that was conducted at 41 and 42 weeks of gestation. Until such a large modern trial is conducted, I would not routinely recommend induction of labour prior to 41 weeks of gestation.
Finally, although induction of labour at 41 weeks of gestation has been found to be cost-effective, it appears that as one moves to earlier gestations, such as 40 weeks of gestation, the intervention is only marginally cost-effective, and could lead to incremental increases of billions of dollars of healthcare costs.