Widespread use of labour induction has led to better outcomes for mothers and babies in Denmark, researchers say today.
The current guidelines in Denmark recommend induction at week 41 plus three to five days for normal risk women to ensure the baby is born by 42 weeks, after which the placenta may not provide adequate support.
About 25% of births in Denmark involve induction when the pregnancy has passed 37 weeks.
This follows the current guidelines from the National Institute for Health and Care Excellence (NICE) in the UK.
A team led by Professor Ojvind Lidegaard, from the University of Copenhagen, Denmark, look at the differences in outcomes once these guidelines came in. The rate of labour induction from 37 weeks rose from 9.1% in 2000 (pre-guidelines) to 26% in 2012, and the rate of pregnancies continuing beyond 42 weeks fell from 8% in 2000 to 1.5% in 2012.
This change was associated with a halving in the risk of neonatal death, from 1.9 to 1.0 per 1,000 births. The risk of asphyxia – a dangerous drop in oxygen levels – fell by 23%, contributing to a 26% drop in the rate of cerebral palsy.
Full details appear in BJOG: An International Journal of Obstetrics and Gynaecology. The authors add that the risk of high birth weight (more than 4,500g) fell by a third, and the risk of peripheral nerve injury fell by 43%.
Professor Lidegaard says: "We have seen significant reductions in newborn asphyxia, neonatal mortality, and peripheral nerve injuries. Another similar study we conducted recently also demonstrated a halving of stillbirths following the implementation of proactive labour induction practice.
"Our results therefore suggest an overall improvement in perinatal outcomes following a national change towards a proactive management of post-term pregnancy through labour induction."
British experts said practice in the UK was not very different from Denmark.
Professor Alan Cameron, of the Royal College of Obstetricians and Gynaecologists, said: “Induction is very common, is offered for good medical reasons and is safe. However, it can be less efficient and more painful than spontaneous labour.
"Induction can also place more strain on labour wards than spontaneous labour and these factors must also be considered."
Journal deputy editor John Thorp said: "Labour induction is a simple intervention, but demands a closer surveillance during labour and hospital settings must be able to support such changes.
“These findings require further education and scrutiny before being implemented in other nations.”
Hedegaard, M. et al. Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study. BJOG 18 February 2015 doi: 10.1111/1471-0528.13299
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