New AMOR-IPAT publication: meta-analysis of risk-based labour induction and term birth outcomes

Nicholson, James M., Lisa C. Kellar, George F. Henning, Maria Colon-Gonzalez, Abdul A. Waheed and Serdar Ural (2015). “The association between the regular use of modeled risk-based labour induction and term birth outcomes: a systematic review and meta-analysis,” BJOG 122(6):773-784.

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ABSTRACT

Background
Despite a lack of high-quality evidence, the use of ‘non-indicated’ term labour induction is increasingly restricted throughout the world.

Objectives
To assess published associations between the regular use of modelled risk-based ‘non-indicated’ term labour induction (hereinafter ‘preventive induction’) and rates of common adverse birth outcomes.

Search strategy
MEDLINE and PUBMED databases were searched electronically.

Selection criteria
Studies were identified that compared term birth outcomes following either the current standard approach with its emphasis on the expectant management of intermediate-level risk or the regular use of preventive induction.

Data collection and analysis
Four studies from four unique databases were identified. A meta-analysis was performed using STATA IC12.

Main results
Pregnancies exposed to the regular use of preventive induction (n = 1153), as compared with pregnancies receiving the current standard approach (n = 1865), experienced a lower caesarean delivery rate (5.7% versus 14.4%; relative risk 0.39, 95% CI 0.31–0.50; I2 P = 0.21), a lower neonatal intensive care unit admission rate (2.9% versus 6.5%; relative risk 0.45, 95% CI 0.31–0.65; I2 P = 0.57), and a lower weighted adverse outcome index score (2.8 versus 6.1).

Conclusions
The regular use of preventive induction, as compared with the current standard approach, was associated with a more favourable pattern of birth outcomes. Other recently published meta-analyses have also determined that certain types of ‘non-indicated’ labour induction are beneficial. Accordingly, the current broad restrictions on ‘non-indicated’ labour induction should be reconsidered. Adequately powered multi-site randomised clinical trials are needed to definitively study the risks and benefits of modelled risk-based ‘non-indicated’ (i.e. ‘preventive’) term labour induction.

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