Women over the age of 35 can safely undergo induced labour, according to the results of a large UK clinical trial published yesterday.
The randomised, controlled study on older first time mothers looked at the whether or not induction is an effective obstetric intervention that is currently being underused.
The results of the NIHR-funded trial, carried out by a research team led by The University of Nottingham and Nottingham University Hospitals Trust, involved 619 older women from across the UK who were pregnant for the first time.
Women over 35 have a higher risk of stillbirth, pre-eclampsia, pregnancy diabetes and problems with the placenta. They are more likely to deliver premature and underweight babies and have a higher risk of having problems in labour. 38% have caesarean sections, although this increases to 50% among women who have their first baby over the age of 40.
The Nottingham trial randomly assigned pregnant women to labour induction via pessary or intravenous hormone drip at 39 weeks or to “expectant care”.
Writing in the New England Journal of Medicine, they revealed that there were no significant differences between the two groups in how many had caesarean sections or in the percentage of women who had a vaginal delivery with forceps or vacuum-assisted delivery.
There were no maternal or infant deaths and no significant differences between the groups in the women’s experience of delivery or in the frequency of adverse outcomes for mother and baby.
Jim Thornton, professor of obstetrics and gynaecology at The University of Nottingham, said: “We were fairly surprised by our main result in that overall there was no significant effect on the rate of caesarean section in the group of mums who were induced at 39 weeks. Our trial was not set up to test induction as a way of avoiding stillbirth but it does prove the safety of performing a much larger trial to test this further.
“Ours is the first clinical trial to provide some hard evidence to help decision-making among doctors and older first-time mothers-to-be. The results support the ‘induce more women’ advocates, although there are still reasons for caution.”
Walker K, Bugg G, Macpherson M et al. The Randomised Trial of Labour Induction in Women 35 Years of Age or Older. N Engl J Med 3 March 2016; 374:813-822. doi: 10.1056/NEJMoa1509117 [abstract]
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