Induction of labour at 39 weeks should be routinely offered to low‐risk women

Abstract

Then, in 2007, a poster was presented from the new Cochrane systematic review, which showed that in lowrisk pregnancies, induction of labour (IOL) before 40 weeks’ gestational age prevented caesarean section. The risk ratio was 0.68 (95% CI 0.34–0.99).1 I was astounded. The authors proposed an Australian randomised controlled trial among lowrisk women for improving perinatal outcomes. It was not undertaken, but the USA ARRIVE Trial was published in 2018. A total of 6106 lowrisk nulliparous women with singleton pregnancies were randomised to planned IOL at 39+0–39+4 weeks or expectant management.2 Severe perinatal complications occurred in 4.3% infants in the IOL group and 5.4% in the expectant group (P = 0.049). Caesarean section occurred in 18.6% of women in the IOL group and 22.2% in the expectant group (P < 0.001). Almost immediately, the American College of Obstetricians and Gynaecologists stated ‘it is reasonable for obstetricians and healthcare facilities to offer elective induction of labor to lowrisk nulliparous women at 39 weeks’ gestation’, a view endorsed by the Society for MaternalFetal Medicine.3 However, the trial also drew criticism based on the perceived lack of generalisability, discrepancies with observational data, availability of other methods to reduce caesarean section rates and unknown costeffectiveness.4–6 Should women be able to choose IOL at 39 weeks, thereby acknowledging a woman's right to autonomy? Or is IOL at 39 weeks so obviously wrong that it should not be discussed as an option, or even actively refused if requested? The aim of this opinion article is to argue the case for offering IOL 39 weeks’ gestational age to lowrisk women.