Sunday, March 04, 2007

Cochrane update on induction for postdates

The Cochrane Review on postdates induction was recently updated. The reviewers found that induction at 41 weeks compared to the currently recommended 42 weeks saved neonatal lives without any increased risk of C-section.

According to Induction of Labour for Improving Birth Outcomes for Women at or Beyond Term (Obstetrics & Gynecology 2007;109:753-754):
Randomized controlled trials conducted in women at or beyond term. The eligible trials were those comparing a policy of labour induction to a policy of awaiting spontaneous onset of labour...

We included 19 trials reporting on 7,984 women. A policy of labour induction at 41 completed weeks or beyond was associated with fewer (all-cause) perinatal deaths... If deaths due to congenital abnormality are excluded, no deaths remain in the labour induction group and seven deaths remain in the no-induction group [0/2985 in the induction group; 7/2951 in the expectant management group]. There was no evidence of a statistically significant difference in the risk of caesarean section for women induced at 41 and 42 completed weeks, respectively... There were fewer babies with meconium aspiration syndrome...

AUTHORS' CONCLUSION: A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small. Women should be appropriately counseled on both the relative and absolute risks.
This finding is consistent with other evidence that shows that the risk of perinatal death increases after 40 weeks (see my recent post on Perinatal mortality and gestational age). The authors believe that the absolute risk of neonatal death is relatively small at 3/1000. It is not clear whether this is high enough to change the recommendations for induction, but it certainly evidence that induction at 41 weeks improves outcomes without increasing the C-section rate compared to waiting until 42 weeks.


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