Inducing labour at 41 weeks in low risk pregnancies is associated with a lower risk of newborn death compared with expectant management (a “wait and see” approach) until 42 weeks, suggests a trial published by The BMJ.
Although the overall risk of death at 42 weeks is low, the team of researchers say induction of labour should be offered to women no later than 41 full weeks.
The trial involved 2,760 women, with an average age of 31 years, and an uncomplicated, single pregnancy. Participants were recruited from 14 Swedish hospitals between 2016 and 2018. Women were randomly assigned to induction of labour at 41 weeks (1,381) or expectant management (1,379) until induction at 42 weeks if necessary.
The main outcome was a combined measure of babies’ health, including stillbirth or death in the first few days of life (known as perinatal death), Apgar score less than 7 at five minutes, low oxygen levels, and breathing problems. But there was no difference between the groups - 2.4% of women in the induction group had an adverse perinatal outcome compared with 2.2% in the expectant management group.
However, six babies in the expectant management group died compared with none in the induction group, and the trial was stopped early. The researchers estimate that, for every 230 women induced at 41 weeks, one perinatal death would be prevented.
Professor Alexander Heazell, Consultant Obstetrician and Spokesperson for The Royal College of Obstetricians and Gynaecologists and Clinical Director of Tommy’s Research Centre on Stillbirth, said:
“We are saddened by reports of babies who died during a research trial in Sweden. The loss of a baby is a devastating tragedy for parents, to the wider family, and the healthcare professionals involved.
“The findings of this Swedish trial are in line with what is already known – that pregnancies that continue to, or pass, 41 weeks are usually safe and straightforward, but there is a small yet significant increase in stillbirth risk.
“Current UK guidance recommends that induction of labour should be offered to women with uncomplicated pregnancies who go beyond 41 weeks to avoid the risks of prolonged pregnancy, including stillbirth. We support the continual review of clinical guidelines as new evidence emerges to ensure best practice.
“A woman's individual needs and preferences should always be taken into account and they must have the opportunity to make informed decisions in partnership with their healthcare professionals.”
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- Link to BMJ research: Induction of labour at 41 weeks versus expectant management until 42 weeks (Swedish post-term induction study, SWEPIS): multicentre, open label, randomised superiority trial
- Pregnancy normally lasts between 37 and 42 weeks. When a pregnancy goes past the ‘due date’ - 40 weeks of pregnancy - women are given a choice about whether they wish to continue their pregnancy, or have a procedure called induction of labour at around 41 weeks of pregnancy, to avoid the risks of prolonged pregnancy, including stillbirth. The exact timing should take into account the woman's preferences and local circumstances, recommends guidance from the National Institute of Health and Care Excellence.
- Women over the age of 40 years have a higher risk of stillbirth and neonatal complications. Therefore, the RCOG recommends that women over 40 should be offered induction at 39–40 weeks of gestation.
- The RCOG remains fully committed, through its ‘Each Baby Counts’ initiative, and in partnership with the NHS and Department of Health, to reduce the number of babies who are stillborn, suffer a neonatal death or severe brain injury.