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Published:March 14, 2020DOI:https://doi.org/10.1016/j.ajog.2020.03.012
      We thank Drs Peleg and Warsof for their letter regarding our manuscript entitled “The impact of induction of labor at 39 weeks in low-risk women on the incidence of stillbirth.” We acknowledge that the background risk of stillbirth increases after 41 weeks gestation. This is applicable to women regardless of their parity.
      In light of data from the ARRIVE trial, there is compelling evidence for maternal benefit for induction of labor at 39 weeks gestation, including the decreased risk of cesarean delivery. We recognize that the ARRIVE trial included only low-risk nulliparous women. Other studies have shown similar results in low-risk multiparous women.
      • Sinkey R.G.
      • Blanchard C.T.
      • Szychowski J.M.
      • et al.
      Elective induction of labor in the 39th week of gestation compared with expectant management of low-risk multiparous women.
      In addition, there is some evidence of worsening neonatal outcome in late-term pregnancy in parous women. Our data add to the existing evidence that supports 39-week induction of labor in low-risk women by also eliminating the risk for stillbirth throughout later gestational ages. Some data show that the widespread adoption of the “39-week rule” in the early 2010s led to an increase in the rate of term stillbirths, because infants who would have delivered possibly a bit earlier (eg, at 37 or 38 weeks gestation) were instead being delivered at 39 weeks.
      • Pilliod R.A.
      • Dissanayake M.
      • Cheng Y.W.
      • Caughey A.B.
      Association of widespread adoption of the 39-week rule with overall mortality due to stillbirth and infant death.
      A recent survey of women in the third trimester of pregnancy suggests that almost one-half are interested in induction of labor before their due date (ie, 39 weeks gestation), even without maternal or fetal indications. This indication should be called “induction for 39 weeks gestation.”
      • Berghella V.
      Induction for 39 weeks’ gestation: let’s call it what it is.

      References

        • Sinkey R.G.
        • Blanchard C.T.
        • Szychowski J.M.
        • et al.
        Elective induction of labor in the 39th week of gestation compared with expectant management of low-risk multiparous women.
        Obstet Gynecol. 2019; 134: 282-287
        • Pilliod R.A.
        • Dissanayake M.
        • Cheng Y.W.
        • Caughey A.B.
        Association of widespread adoption of the 39-week rule with overall mortality due to stillbirth and infant death.
        JAMA Pediatr. 2019; ([Epub ahead of print.])https://doi.org/10.1001/jamapediatrics.2019.3939
        • Berghella V.
        Induction for 39 weeks’ gestation: let’s call it what it is.
        AJOG MFM. 2020; 100098

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