[INDUCTION OF LABOR AT 39 WEEKS OF GESTATION VERSUS EXPECTANT MANAGEMENT]

Maternal-Fetal Medicine Unit, Galilee Medical Center, affiliated with the Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel Elective induction of labor is a non-indicated intervention performed in order to induce labor. In contrast, non-elective induction of labor can be performed because of medical or obstetrical indications such as hypertension, intrauterine growth restriction, oligohydramnios or post-term pregnancy. Labor induction should be avoided before 39 weeks 0 days since it is associated with adverse neonatal outcomes. Fetal mortality rate increases with advanced gestational age beyond 39 weeks. Induction of labor is recommended at 41 weeks of gestation or later in low-risk pregnancy. The risk of stillbirth at this point of pregnancy is 2 to 3 per 1000 deliveries. The benefits of elective induction of labor include reduced risk of stillbirth, Meconium aspiration syndrome and their attendant consequences. Furthermore, elective induction of labor enables women to schedule the time of delivery. On the other hand, elective induction of labor may have some disadvantages, as it may prolong hospital stay and increase cost and resource utilization. Currently, elective induction of labor is not routinely recommended before 41 weeks of gestation since it was widely assumed to increase cesarean section rates especially among nulliparous women with a low Bishop's score. This assumption is based mainly on previous retrospective studies which demonstrated an increased cesarean section rate especially in nulliparous women who underwent elective induction of labor compared to spontaneous labor. Observational studies from the last decade and recent randomized studies comparing elective induction of labor with expectant management of pregnancy in nulliparous women did not demonstrate elevated cesarean section rate in the induction group. In addition, some of these studies have shown decreased cesarean section rate along with decreased maternal and neonatal complications in women managed with elective induction of labor. The purpose of this review is to present current literature on the subject of elective induction in 39 weeks versus expectant management in nulliparous women and its effect on maternal and neonatal outcomes and cesarean section rates.