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Offer induction of labour by 41 weeks, researchers recommend

Pregnant women should be offered an induction by 41 weeks to reduce the risk of perinatal mortality, researchers have recommended.

Women should be informed of the risks of going past 41 weeks’ gestation, they said, after research found that induction could reduce the risk of perinatal death.

The study, carried out by researchers in Sweden and published in the BMJ, looked at just under 3000 women with low-risk pregnancies who were assigned to be either induced at 41 weeks or to the expectant management group, which used a ‘wait and see’ approach up to 42 weeks.

Taking into account factors including stillbirth, neonatal death, oxygen levels, Apgar scores and breathing problems, the researchers found no significant difference in outcomes for the babies between the two groups.

However, the researchers were recommended to stop the study early after five intrauterine deaths and one neonatal death occurred in the expectant management group. There were no stillbirths or neonatal deaths in the group that were induced.

Babies in the induction group were also about a third less likely to be admitted to NICU than those in the expectant management group. The number of women needing to be induced to prevent one perinatal death was 230.

The researchers said that overall risk of perinatal death after 41 weeks was low and that the study was limited due to differences in local practices for induction and difficulty knowing the exact cause of the stillbirths.

They did recommend, however, that ‘although these results should be interpreted cautiously, based on previous reports and the results of the present trial we suggest that labour induction should be offered to women at 41 weeks+0 days or earlier and could be one (of few) interventions that reduces the rate of stillbirths.’

Writing in a linked editorial, Professor Sara Kenyon, professor of evidence based maternity care at the University of Birmingham, and colleagues said: ‘Choice is important within maternity care, and clear information about available options should be accessible to all pregnant women, enabling them to make fully informed and timely decisions.’

The study comes as research published earlier this year showed a significant risk of stillbirth in pregnancies that continued beyond 40 weeks.

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