Authors' objectives: Background The average length of human gestation is 40 weeks from the first day of the last menstrual period but can vary by several weeks. During 2018, 22% of deliveries in Region Västra Götaland (VGR) in Sweden occurred at 41 gestational weeks and 0 days (41+0) or later (prolonged pregnancy) and 6.1% at week 42+0 or later (post term pregnancy). Observational studies show that post term compared with term deliveries are associated with increased perinatal mortality and morbidity as well as maternal morbidity. Induction of labour (induction) before post term is used to avoid these adverse effects but is controversial since the procedure is associated with adverse effects such as prolonged labour, adverse neonatal outcome, uterine hyperstimulation, and an increased risk of uterine rupture. A Health Technology Assessment (HTA) report from our HTA unit in 2012 evaluating induction between weeks 41+0 to 42+0 versus expectant management with different upper limits of gestational age (in some studies up to 44 weeks) showed lower perinatal mortality and morbidity and no difference in caesarean delivery rates with early induction. Various guidelines from different countries recommend induction between weeks 41+0 and 42+0. Today, most obstetric units in Sweden offer induction at gestational week 42+0. Question at issue Is a strategy of induction at 41 weeks + (0 to 2 days) compared with a strategy of expectant management with various regimes of foetal surveillance and induction at 42 weeks + (0 to 1 day) superior in terms of decreased stillbirth/neonatal mortality and neonatal morbidity without increasing maternal mortality and morbidity, in healthy women with an uncomplicated singleton pregnancy?

Authors' results and conclusions: This systematic review, including three RCTs with 5,161 women and comparing the strategies to induce labour at 41 completed weeks with expectant management including various regimes of foetal surveillance and induction at 42 completed weeks, shows that stillbirth/neonatal mortality may be reduced but to an uncertain extent, while any direction of the effect on stillbirth/neonatal mortality and neonatal morbidity combined is uncertain. There were, or were probably, no differences between the groups for important maternal outcomes.

Project Status: Completed

Year Published: 2020

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-1728378332-382/native/2020_111%20HTA-rapport%20Induction%20of%20labour%20at%2041%20or%2042%20weeks%20of%20gestation.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se