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Journal Summary: Labour induction in women aged 35 years or older: RCT

Induction of labour at 39 weeks for women age 35 years or older does not increase the risk of caesarean section or instrumental vaginal delivery. This has relevance for the prevention of term stillbirths in women aged 35 years or more

Walker KF, Bugg GJ, Macpherson M, et al. Randomized Trial of Labor Induction in Women 35 Years of Age or Older. N Engl J Med 2016; 374: 813-822.

Summary

The average age of women at childbirth in high-income countries has continued to rise for the past three decades. The risk of term antepartum stillbirth increases with maternal age, particularly for women aged 35 years or older.

This randomised controlled trial included 619 primigravid women aged 35 years or more, randomized to labour induction between 39+0 and 39+6 weeks gestation or expectant management. The primary outcome was caesarean section. The study was not powered to detect a difference in stillbirths.

There were no significant differences between the induction and expectant management groups in the risk of caesarean section or assisted vaginal delivery. There were no significant differences in short term neonatal outcomes or maternal childbirth satisfaction scores.

Clinical implications

Induction of labour at 39 weeks in primigravida women aged 35 years or more does not increase the risk of caesarean section or instrumental vaginal delivery. Induction of labour at 39 weeks to avoid term stillbirth in older women appears to be a safe intervention to consider.

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