Main Findings
This national retrospective cohort study analyzed data from a total of
1,885,694 singleton, non-anomalous, low-risk pregnancies in the United
States of America. From a maternal perspective, our data demonstrates a
significantly lower frequency of triple I and cesarean delivery in women
who underwent induction of labor at 39 weeks gestation as compared to
the expectant management group. Induction of labor was associated with
increased rates of cesarean hysterectomy. Although the risk was found to
be 30% higher than the expectant management group, it is important to
note that the absolute risk for this complication remains very low and
was detected due to this study’s large sample size. Labor induction did
not result in any statistically significant difference in the frequency
of blood transfusion, ICU admission, or uterine rupture when the two
groups were compared. From a neonatal perspective, our data demonstrates
that labor induction at 39 weeks gestation resulted in a significantly
lower frequency of 5 minute Apgar ≤ 3, requirement for ventilation,
seizures and/or NICU admission than in the expectant management group.
In contrast, labor induction did not result in any significant
difference in the frequency of neonatal death between the two groups.
Taken together, these findings demonstrate that induction of labor at 39
weeks gestation is associated with: (i) a lower risk of developing
triple I and requiring a cesarean delivery, (ii) a small increased risk
for cesarean hysterectomy, and (iii) a significantly reduced frequency
of neonatal morbidity when compared with an expectantly managed
pregnancy.