In late 2017, Michael B, Michael C, and Chantelle all attended a global Obstetric conference held in Melbourne. Topics were all extremely relevant to everyday Obstetric practice, and the conference was a sell-out. Presentations varied widely but included discussions surrounding steroids for Caesarean section, delayed cord clamping, prevention of preterm birth, growth restricted babies, and also gave us an insight into Obstetric practice in South Africa and Hong Kong. Many of the speakers were leading world specialists in their field.
The final presentation for the conference was given by a speaker from the USA (Bill Grobman). He presented a somewhat tongue-in-cheek discussion regarding the above - i.e. is there a case to induce everyone at 39 weeks? Whilst the OGB Clinicians pride ourselves on providing individualised care and induction when necessary, some very interesting points were made. After 39 weeks there is a slow rise in the incidence of Caesarean section, delivery using vacuum and forceps, and bleeding. It is also well known that the risk of stillbirth similarly increases from 39 weeks. This has always been balanced by the thought that induction of labour increases the likelihood of Caesarean section. But is this really the case?
Bill however presented some evidence showing that the rate of Caesarean section in those women induced at 39 weeks was 30%, compared with a 31% risk by waiting for spontaneous labour up to 42 weeks gestation. This study included 619 women and was based in the UK. The study wasn’t designed to measure outcomes for babies, but we would expect a reduction in bad outcomes due to the known risks of increasing gestation.
A much larger trial is now underway which we hope will provide more information (the ARRIVE trial). Once this is published there may be a stronger case for induction at 39 weeks.
For the time being we would advocate induction only when necessary for medical reasons, but the evidence that we have to hand at least makes it reasonable to induce at 39 weeks if requested. Of course there will be situations where this is not appropriate - outcomes from induction will be better if the cervix is favourable.
Please feel free to discuss this further with your OGB doctor. As a group we all stay up to date with best practice worldwide, and always aim to provide the best possible care to you, every time.
- Michael Bardsley
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