2019•Obstetric Anesthesia DigestRequires access
Induction of Labour at 41 Weeks Versus Expectant Management Until 42 Weeks (INDEX): Multicentre, Randomized Noninferiority Trial
Judit K. J. Keulen, Aafke Bruinsma, Joep C. Kortekaas, Jeroen van Dillen, Patrick M. Bossuyt, Martijn A. Oudijk, Ruben G. Duijnhoven, Anton H. van Kaam, Frank P.H.A. Vandenbussche, Joris van der Post, B.W. Mol, Esteriek de Miranda
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Abstract
(BMJ. 2019;364:I344) Because of the fact that postterm pregnancy (defined as pregnancy extended to or beyond 42 weeks gestation) has been associated with increased perinatal morbidity and mortality, induction of labor is recommended after 42 weeks gestation. Although the probability of positive outcomes for neonates born between 40 and 42 weeks gestation is overall considered good, the risk of adverse outcomes has been shown to increase gradually after 40 weeks gestation. Several studies have found that induction of labor at 41 weeks gestation and later, rather than waiting for the onset of spontaneous labor improves perinatal outcomes. However, there is much heterogeneity among these trials based on the different outcome measures, protocols, and time frames used in the various studies. This current study compared 2 management strategies: induction of labor at 41 weeks gestation or expectant management until 42 weeks gestation with subsequent induction of labor had not begun.