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    Rates of unintended pregnancy in US at historic low

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    Does labor induction in older women increase cesarean risk?

    Results of a recent UK randomized controlled trial published in The New England Journal of Medicine suggest that inducing labor at 39 weeks’ gestation in women aged 35 or older may not increase the risk of cesarean delivery.

    Researchers assessed outcomes in 619 primigravidas aged 35 or older but the trial, which was conducted at 38 hospitals and 1 Primary Care Trust organization in UK, was not powered to look at the effects of labor on stillbirth. The women were randomly assigned to either labor induction between 39 weeks 0 days and 39 weeks 6 days gestation or to expectant management. In most participating institutions, induction was with prostaglandin followed, if necessary, by amniotomy and oxytocin infusion.

    Related: Cesarean scar pregnancy diagnosis and management

    Following an intention-to-treat analysis, researchers found no significant differences in the number of cesarean deliveries between the 2 groups. Of the 304 women in the induction group, 98 had cesarean deliveries versus 103 of the 314 women in the expectant management group (relative risk [RR], 0.99; 95% confidence interval [CI], 0.87 to 1.14). In addition, no significant difference was seen between the 2 groups in use of forceps or vacuum during vaginal delivery (115 of 304 induction versus 104 of 314 expectant management group [RR, 1.30; 95% CI, 0.96 to 1.77]). No maternal or infant deaths were recorded and no significant difference between the two groups was seen in the frequency of adverse events.

    The researchers concluded that inducing labor at 39 weeks’ gestation in women aged 35 or older does not appear to have a significant impact on the rate of cesarean delivery nor does it adversely affect short-term maternal or neonatal outcomes. They noted, however, that the results may not be generalizable to older multiparas or apply to all nulliparas aged 35 and older because only nulliparas who did not have high-risk pregnancies were enrolled. 

    NEXT: Does prenatal vitamin D boost bone in neonates?

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

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