[Assessment of the benefit-harm balance depending on gestationnal age to induce delivery for post-term pregnancies]

Abstract

Objectives: To attempt to determine for post-term pregnancies the optimal gestational age when the benefit-harm balance is in favor of induction labor in comparison with an expectative management including close monitoring.

Methods: Articles were searched using PubMed, Embase and Cochrane library.

Results: Current literature data are insufficient to demonstrate that routine labor induction is superior, inferior or equivalent to an expectant management to reduce maternal and perinatal mortality and morbidity (EL2). Although it is impossible to determine certainly a gestational age for which the benefit-harm balance is in favor of induction labor, epidemiological data regarding the perinatal mortality suggest that an expectant management is an unreasonable option after 42 completed weeks (EL3). Current data are insufficient to state positively or negatively that routine labor induction is associated significantly to a lower rate of cesarean delivery in comparison with an expectant management (EL2). There is no evidence of a statistically significant difference in the risk of cesarean section between the two policies for women with favorable cervices (Bishop score ≥ 5) (EL2).

Conclusions: Induction of labor at 41(+0) to 42(+6)weeks should be proposed to women with uncomplicated post-term pregnancies (EL2). The optimal age gestionnal for induction will depend mainly on maternal characteristics (EL4), but also on women's preferences and organization of maternity cares, after having delivered information regarding the benefits and harms of both labor induction and expectant management (expert opinion). After 42(+0)weeks, expectant management is a possible option (expert opinion). Nevertheless, it may be associated with an increase of risks for the fetus, that must be explained to the patient and be weighed against the possible disadvantages of an induction of labor (expert opinion).