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EBM verdict
When is the right time to induce labour?
  1. Meera Garriga1,
  2. Janneke van't Hooft2
  1. 1 School of Medicine, University of California, San Francisco, San Francisco, California, USA
  2. 2 METRICS at Stanford, Stanford University, Stanford, California, USA
  1. Correspondence to Ms Meera Garriga, University of California San Francisco, San Francisco, CA 94143, USA; meera.garriga{at}ucsf.edu

https://doi.org/10.1136/bmjebm-2019-111330

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    The recent multicentre, randomised trial Swedish Post-term Induction Study provides evidence that induction of labour in pregnant women no later than at 41 weeks can reduce the rate of stillbirths and is preferred over expectant management.

    The average pregnancy lasts about 40 weeks from the start of a woman’s last menstrual period, but only about 5% of women deliver at exactly 40 weeks.1 While any delivery between 37 and 42 weeks is within normal range, adverse perinatal outcomes, including stillbirth and maternal complications, gradually increase past 40 gestational weeks and are significantly increased post-term (>42 weeks). Induction of labour may mitigate these adverse outcomes.

    The latest Cochrane review (2018)2 highlighted evidence in favour of induction, but the question of when exactly to advise induction was left unresolved. While current guidelines in the UK3 and USA4 recommend induction of labour no later than 42 weeks, several studies suggest that the risk of adverse perinatal outcomes already increases significantly at 41 weeks. There is a paucity of data addressing induction between 41 and 42 weeks: only two of 30 studies included in the Cochrane review address this time …

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    Footnotes

    • Contributors MG and JvtH drafted the manuscript and both provided critical revisions.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.