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Elective Induction of Labor Compared With Expectant Management of Nulliparous Women at 39 Weeks of Gestation : A Randomized Controlled Trial . OBJECTIVE To evaluate whether the elective induction of labor in nulliparous women with an unfavorable cervix affects the cesarean delivery rate . METHODS We conducted a randomized controlled trial at a tertiary care medical center . Nulliparous woman between 38 0/7 and 38 6/7 weeks of gestation who were least 18 years of age with a singleton gestation and a Bishop score of 5 or less were randomized to elective induction of labor or expectant management . The induction of labor group was induced within 1 week of enrollment but not before 39 0/7 weeks of gestation . The control group continued routine prenatal care with admission for labor or obstetric indication . The primary outcome was cesarean delivery . Assuming a 20 % rate in women in a control group , 80 % power , and a goal to detect a twofold increase to 40 % in the induction of labor group , 162 patients were needed . RESULTS From March 2010 to February 2014 , 82 patients were randomly allocated to induction of labor and 80 to expectant management . Baseline characteristics were similar between groups . The cesarean delivery rate in the induction of labor group was 30.5 % ( 25/82 ) compared with 17.7 % ( 14/79 ) in the expectant management group ( relative risk 1.72 , 95 % confidence interval 0.96-3.06 ) . CONCLUSION In nulliparous women with a Bishop score of 5 or less , elective induction after 39 0/7 weeks of gestation compared with expectant management of pregnancy did not double the rate of cesarean delivery . CLINICAL TRIAL REGISTRACTION ClinicalTrials.gov , www.clinicaltrials.gov , NCT01076062 . LEVEL OF EVIDENCE I .
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Intervention_Physical
Elective Induction of Labor
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Intervention_Physical
Expectant Management of Nulliparous Women
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Intervention_Physical
elective induction of labor
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Intervention_Physical
elective induction of labor
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Intervention_Physical
expectant management
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Intervention_Physical
induction of labor
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Intervention_Control
prenatal care with admission for labor
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Intervention_Control
obstetric indication
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Intervention_Physical
elective induction
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Intervention_Physical
expectant management of pregnancy
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Outcome_Physical
cesarean delivery rate
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Participant_Sex
Women
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Participant_Condition
Gestation
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Participant_Sex
women
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Participant_Condition
unfavorable cervix
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Participant_Age
18 years of age
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Participant_Sample-size
82 patients