Rapid induction of labour for pregnant women aged 35 years or over may reduce the risk of perinatal death, British researchers say today.
Senior obstetricians called for more research, warning of “enormous implications” from the findings, which suggest that induction is best offered at 40 weeks of gestation rather than later.
Induction is frequently offered to pregnant women at 41 and 42 weeks of gestation to cut the risk of pregnancy complications, which is low but slightly higher for women having their first baby at age 35 or over.
The study used figures from English Hospital Episode Statistics covering 77,327 first time mothers aged 35 to 50 years. This covered nearly 80,000 UK women. Analysis showed that induction at 40 weeks had a lower risk of perinatal death than care according to current guidelines – induction in week 41 or 42.
Inducing labour one to two weeks earlier was linked to a fall in the risk of perinatal death from 26 per 10,000 pregnancies to eight per 10,000 pregnancies.
Lead author, Hannah Knight, said: "The number of first-time mothers over the age of 35 is rising. Although their risk of experiencing a stillbirth or neonatal death is relatively small, it’s still very important that these women receive the best advice on how to minimise the risks to themselves and their baby.
“This study represents the strongest evidence yet that moving the offer of induction forward to 40 weeks might reduce the risk of stillbirth in this specific age group, which we know face a greater risk of stillbirth and neonatal death."
Professor Lesley Regan of the Royal College of Obstetricians and Gynaecologists commented: "The study finds a significant reduction in the risk of perinatal death, but the absolute risk is still low even among older mothers.
“The implications of such a change in policy would be enormous, so further research is needed."
Knight, H. E. et al. Perinatal mortality associated with induction of labour versus expectant management in nulliparous women aged 35 years or over: An English national cohort study. PLoS Medicine 14 November 2017; doi: 10.1371/journal.pmed.1002425 [abstract]
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