A randomized controlled trial comparing labor induction at 40 versus 41 weeks in low-risk post-date pregnant women

Anjali Soni; Divya Khurana; Chanderdeep Sharma

doi:10.18203/2320-1770.ijrcog20252318

Authors

Anjali Soni Department of Obstetrics and Gynecology, Dr R. P. Government Medical College, Kangra at Tanda, Himachal Pradesh, India
Divya Khurana Department of Obstetrics and Gynecology, Dr R. P. Government Medical College, Kangra at Tanda, Himachal Pradesh, India
Chanderdeep Sharma Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20252318

Keywords:

Foley’s catheter, Induction of labor, Post-date pregnancy, 40 weeks, 41 weeks

Abstract

Background: To determine effect of expectant management till 41 weeks versus labor induction (IOL) at 40 weeks, on spontaneous labor onset (SOL), in low-risk post-date (>40 weeks) women.

Methods: A randomized controlled trial was conducted among low-risk post-date women. At enrolment two hundred women were randomized (group 1; IOL at 40 weeks versus group 2; expectant management till 41 weeks). Demographic and clinical data were collected at enrolment and delivery.

Results: Three-fourth of women (76%) in group 2 had SOL. Additionally, duration of labor (minutes) [median±IQR; 380 (325-417) versus 410 (380-482), p<0.001], delivery within 12 hours (n; 87 versus 45, p<0.001) and within 12-24 hours of admission (n; 1 versus 42, p<0.001) was statistically significantly better in group 2. There was no statistically significant difference regarding mode of delivery (n) [vaginal delivery; 87 vs. 88, or cesarean section (CS); 13 versus 12, p=0.887] and indications of CS (fetal distress; 12 versus 12, and failure of induction of labor 1 versus nil, p=1.000) and maternal and fetal/neonatal outcomes. With an absolute risk of 21% of SOL, five women should be offered expectant management till 41 weeks for one woman to have SOL.

Conclusions: In low- and middle-income countries, low-risk post-date pregnant women should be offered expectant management of pregnancy till 41 weeks awaiting spontaneous labor (76%), with maternal and fetal/neonatal outcomes comparable to routine IOL at 40 weeks.

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