Elective Induction of Labor at 39 Weeks Versus Expectant Management in Low-Risk Nulliparous Women: Randomized Trial

Objective: Timing of delivery is vital for a healthy pregnancy outcome. An increase in morbidity and mortality exists on both extremes of gestation, preterm and postterm. This study's objective was to compare the elective induction of labor at 39 weeks gestational age among low-risk nulliparous women with singleton pregnancies to expectant management. Material and Methods: It was a randomized control study over 1 year. Low-risk nulliparous, singleton live pregnancy with a cephalic presentation at >38 weeks were included. Women not consenting, high-risk pregnancy, contraindications to vaginal delivery, and unreliable dates were excluded. Women were randomized into Group A-low-risk nulliparous, singleton live pregnancy with cephalic presentation induced at 39 to 39+ 3 weeks. Group B-low-risk nulliparous expectantly followed and induced after 41 weeks. Results: A total of 300 women were included in the study, 147 were included in Group A and 153 in Group B. Cesarean section rate was similar with 25.2% in group A compared to 24.8% in group B. Neonatal morbidity increased in group B (27.5%) compared to group A (15.6)% with p value of <0.013. Conclusion: Elective induction at 39 weeks of gestation did not increase cesarean rates & had better neonatal outcomes than the expectant group. Elective labor induction should be a shared decision-making process with informed consent.