Elective induction of labor: a prospective clinical study, I: Obstetric and neonatal effects

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Abstract
Elective induction of labor is still a controversial obstetric procedure. The safety of the procedure and the possibility to program labor during daytime is an often heard argument in favor of it. Also the possibility to prevent term intrauterine fetal death of unknown cause and the possibility to apply fetal monitoring from the beginning of labor are put forward as arguments in favor of elective induction of labor. Feelings of unnaturalness and the dangers of prematurely induced delivery are the most often heard arguments against it. We performed a prospective study to determine the differences between elective induction of labor and spontaneous labor. During 17 consecutive months a group of 184 elective inductions was studied in the Department of Obstetrics, University Hospital-Dijkzigt, Rotterdam. Only healthy women with an uncomplicated pregnancy were included in the study group and all women were allowed a free choice of elective induction or spontaneous labor. The reference group was composed by a system of "matched controls". For induction of labor a standard technique including artificial rupture of the membranes and constant intrauterine fetal monitoring was used. Oxytocin was administered intravenously in an incremental dose. After delivery the acid-base status of the newborns was determined, and part of the newborns were subjected to a neurological screening according to Prechti. The development of the infants was followed during one year during a "psychomotor development scheme 0-15 months". The duration of pregnancy appeared to be three days shorter in the induction group than in the reference group. Also the first stage of labor was significantly shorter in the induction group as compared to the reference group. It appeared possible to program labor almost exclusively during daytime. Meconium stained amniotic fluid occurred significantly less frequently in the induction group than in the reference group. In one patient the induction of labor could be held responsible for the necessity to perform a cesarean section. There was a significantly higher percentage of vacuum and forcepts deliveries in the induction group (11.9%) than in the reference group (4.5%). No difference between birthweights, Apgar scores and umbilical arterial blood gas values in the two groups were found. Neither the neurological screening nor the follow-up study of the infants revealed any differences between the two groups. We were not able to confirm the often postulated greater safety of the procedure. A greater number of vacuum and forceps deliveries in the induction group could, in retrospect, not be explained by a higher frequency of fetal distress in this group. This study did not provide sound arguments against or in favor of the procedure of elective induction of labor. It is concluded that the decision to electively induce labor must be based on considerations other than somatic ones.

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