The aim of this study was to evaluate the risk of cesarean and any maternal and perinatal
effects of a policy induction of labor in uncomplicated full-term singleton gestations.
Searches were performed in an electronic database with the use of a combination of
text words related to “induction” and “cesarean section” from inception of each database
through December 2014. We included all randomized controlled trials of uncomplicated
singleton gestations at full term (ie, between 39 weeks 0/7 days and 40 weeks 6/7
days) with intact membranes randomized to induction of labor or control (ie, expectant
management). The primary outcome was the incidence of cesarean delivery. The summary
measures were reported as risk ratio (RR) with 95% confidence interval (CI). Five
randomized controlled trials, including 844 women, were analyzed. Full-term vertex
singleton gestations receiving induction of labor had similar incidence of cesarean
delivery compared to controls (9.7% vs 7.5%; RR, 1.25; 95% CI, 0.75–2.08). Rates of
spontaneous (75.9% vs 80.2%; RR, 0.95; 95% CI, 0.87–1.02) and operative (13.1% vs
10.6%; RR, 1.22; 95% CI, 0.83–1.81) vaginal delivery were also similar. Induction
was associated with similar rates of chorioamnionitis (9.6% vs 8.0%; RR, 1.17; 95%
CI, 0.38–3.39), but statistically significantly less blood loss (mean difference –57.59
mL; 95% CI, –83.96 to –31.21) compared to controls. Regarding neonatal outcomes, induction
was associated with a significantly lower rate of meconium-stained amniotic fluid
(4.0% vs 13.5%; RR, 0.32; 95% CI, 0.18–0.57) and significantly lower mean birthweight
(mean difference –135.51 g; 95% CI, –205.24 to –65.77) compared to control group.
Induction of labor at full term in uncomplicated singleton gestations is not associated
with increased risk of cesarean delivery and has overall similar outcomes compared
to expectant management.
Key words
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Article Info
Publication History
Published online: April 13, 2015
Accepted:
April 6,
2015
Received in revised form:
March 17,
2015
Received:
January 11,
2015
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
