A CLINICAL-TRIAL OF INDUCTION OF LABOR VERSUS EXPECTANT MANAGEMENT INPOSTTERM PREGNANCY

OBJECTIVE: Management of the uncomplicated pregnancy prolonged beyond the estimated date of confinement is controversial, particularly when the cervix is unfavorable for induction. The benefit of reducing poten tial fetal risk with induction of labor must be balanced against the m orbidity associated with this procedure. The objective of this study w as to compare two strategies for managing postterm pregnancy (i.e., im mediate induction and expectant mangement). STUDY DESIGN: Four hundred forty patients with uncomplicated pregnancies at 41 weeks' gestation were randomized to either immediate induction of labor (n = 265) or ex pectant management (n = 175). Patients with expectant management under went nonstress testing and amnioic fluid volume assesment twice per we ek. Patients in the induction group underwent induction within 24 hour s of randomization. To evaluate the efficacy of intracervical prostagl andin E2 gel, patients in the induction group were randomized in a 2:1 scheme to receive either 0.5 mg prostaglandin E2 gel or placebo gel i ntracervically 12 hours before induction of labor with oxytocin. RESUL TS: The incidence of adverse perinatal outcome (neonatal seizures, int racranial hemorrhage, the need for mechanical ventilation, or nerve in jury) was 1.5% in the induction group and 1% in the expectant manageme nt group (p > 0.05). There were no fetal deaths in either group. There were no differences in mean birth weight or the frequency of macrosom ia (birth weight a 4000 gm) between the two groups (p > 0.05). Regardl ess of parity, prostaglandin E2 intracervical gel was not more effecti ve than placebo in ripening the cervix. The cesarean delivery rate was not significantly different in the expectant (18%), prostaglandin E2 gel (23%), or placebo gel (18%) groups. CONCLUSIONS: Adverse perinatal outcome in otherwise uncomplicated pregnancies of greater-than-or-equ al-to 41 weeks is very low with either of the management schemes descr ibed. Thus from the perspective of perinatal morbidity or mortality ei ther management scheme is acceptable.