Quick Take: Induction of Labor at 41 Weeks Versus Expectant Management Until 42 Weeks (INDEX): Multicenter, Randomized Non-Inferiority Trial

It has been well established that pregnancy extending beyond 42 weeks is associated with higher rates of perinatal morbidity and mortality. However, there is variability in the current management of pregnancies extending beyond 41 weeks. In this randomized controlled non-inferiority trial, 1801 low-risk women with an uncomplicated singleton pregnancy were randomized to undergo either induction of labor at 41 weeks or expectant management until 42 weeks to compare outcomes in perinatal mortality and neonatal morbidity. A composite score of perinatal mortality and neonatal morbidity, as measured by the presence of any of several pathologies or admission to the Neonatal Intensive Care Unit, was used as the primary outcome. Researchers found that expectant management, with 3.1% of women having adverse perinatal outcomes, was inferior to induction of labor at 41 weeks, with 1.7% of women having adverse outcomes in that group (absolute risk difference -1.4%, 95% CI -2.9% to 0.0%, p=0.22 for non-inferiority). In addition, infants in the induction group were less likely to have an Apgar score less than 7 at 5 minutes when compared to the expectant management group (RR 0.48, 95% CI 0.23 to 0.98). The two treatment arms did not differ in terms of rates of caesarean section or adverse maternal outcomes. This study therefore shows that induction of labor at 41 weeks in low-risk women with an uncomplicated singleton pregnancy is associated with improved perinatal outcomes.

Click to read the study in the BMJ

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