New research from Queen Mary University of London has found risk of caesarean delivery was 12% lower among women whose labour was induced, compared with women who were managed with a "wait-and-see" approach (expectant management). The findings are contrary to the popular view that inducing labour (starting labour artificially) increases risk of caesarean delivery.
Labour is induced in about 20% of all births for a variety of reasons such as pre-eclampsia, diabetes, preterm rupture of the membranes, overdue pregnancy and fetal distress. Induction is often thought to be associated with increased risk of caesarean deliveries despite evidence indicating a lower risk. However, there has been a need for further, more robust, evidence.
The study, published in the CMAJ (Canadian Medical Association Journal), involved a systematic review and analysis of 157 randomised controlled trials that included 31 085 deliveries to determine whether there is an increased risk of caesarean delivery associated with induction compared with expectant management.
Khalid Khan, Professor of Women's Health and Clinical Epidemiology at Queen Mary University of London, comments: "The risk of caesarean delivery following induced labour was significantly lower than the risk associated with expectant management. This finding supports evidence from systematic reviews but is contrary to prevalent beliefs and information from consumer organisations, guidelines and textbooks."
The researchers found a 12% lower risk of cesarean delivery in term or post-term pregnancies that were induced but not in preterm births. The risk was lower in both high-risk and low-risk pregnancies, and the risk of fetal death or complications was lower in women who were induced compared with those managed expectantly.
Prostaglandin E2, commonly used in the UK, Canada and the United States to induce labour, was associated with significant reductions in the risk of caesarean delivery. However, oxytocin and amniotomy, also widely used, did not show a decreased risk of caesarean delivery.
Professor Khan continues: "These findings show that inducing labour is a way to increase the likelihood of a vaginal birth. Our meta-analysis has provided a robust answer to the disputed question of risk of caesarean delivery associated with induction of labour. Women whose labour was induced were less likely than those managed expectantly to have a caesarean delivery. In addition, the risk of fetal death and admission to neonatal intensive care unit were decreased in the induction group.”
The researchers note this evidence may have clinical practice implications by helping physicians determine who should be induced and in explaining the risks of induction.
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