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RCOG position on PLOS Medicine study: Inducing first-time mothers aged 35 and over earlier could reduce stillbirths and neonatal deaths

News 15 November 2017

A study published in PLOS Medicine has found that inducing first-time mothers aged 35 and over at 40 weeks could reduce the risk of stillbirth and neonatal death (the death of a baby 7 days after birth), when compared to current guidelines which recommend induction of labour between 41 and 42 weeks for all women regardless of age.

The UK researchers analysed data from NHS Hospital Episode Statistics covering 77,327 first time mothers aged 35-50. They compared the risk of stillbirth or neonatal deaths (perinatal mortality) between induction of labour at 39, 40 and 41 weeks and expectant management – continuing the pregnancy to either spontaneous labour, induction of labour or caesarean section at a later date.

This study found that pregnant women aged 35 and over who were induced at 40 weeks were two thirds less likely to experience a stillbirth or neonatal death compared to women who received care according to the current guidelines. Induction of labour at 40 weeks in this age group was linked to the risk of perinatal death falling from 26 per 10,000 pregnancies to 8 per 10,000 pregnancies, with the data indicating that one death would be avoided for every 526 inductions of labour.

Commenting on the study, Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists (RCOG), said:

“This large study supports emerging research which suggests that moving forward the offer of induction to 40 weeks may play a role in reducing the proportion of stillbirths and neonatal deaths, but it should be emphasised that this study is the first to focus on a specific patient group – first time mothers aged 35 and over.

“The study finds a significant reduction in the risk of perinatal death, but the absolute risk is still low even among older mothers. However the findings are important because the age at which women are having their first baby is rising with 14 per cent of first time mothers in the UK now aged 35 and over. Due to a range of social, professional and financial factors this trend is unlikely to reverse, therefore specific recommendations regarding timing of delivery in older mothers could support future practice in the UK.

“The RCOG welcomes any new research which may help to reduce stillbirth and neonatal death rates, however, as the authors acknowledge, the implications of such a change in policy would be enormous for both the health service and women themselves so further research to determine the impact of such a change in practice is needed. While induction is safe and studies have shown no short-term adverse impact on mother or baby, induction of labour represents an intervention, is associated with costs to the service, and can be a more prolonged process than spontaneous labour. These findings should help women over the age of 35 make an informed choice with regards to induction of labour and are likely to influence the production of future guidelines.

“Through our Each Baby Counts initiative and in partnership with the NHS and Department of Health, the RCOG is committed to halving the number of babies who are stillborn, suffer a neonatal death or severe brain injury by 2030.”

Notes to editors:

For media enquiries please contact the RCOG press office on 020 7045 6773 or email pressoffice@rcog.org.uk

Induction is very common and around one in three labours start with an induction in the UK. The current guidelines from the National Institute for Health and Care Excellence (NICE) recommend that women with uncomplicated pregnancies should be given the opportunity to go into spontaneous labour and are usually be offered induction of labour between 41 and 42 weeks to avoid the risks of prolonged pregnancy, which can include stillbirth.

In the UK, the absolute risk of perinatal mortality is low, affecting approximately 5.6 in 1,000 babies in 2015. The stillbirth rate was 3.87 per 1,000 births and the neonatal death rate was 1.74 per 1,000 births.

About the RCOG

The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision. For more information, visit www.rcog.org.uk or follow us on Twitter @RCObsGyn.