Labor Induction Versus Expectant Management-A Scoping Review of Randomized Controlled Trial Evidence

Induction of labor is increasingly used across diverse obstetric indications, yet uncertainty persists regarding its impact on neonatal outcomes compared with expectant management across gestational ages. This scoping review aimed to map the scope, characteristics, and findings of randomized controlled trial (RCT) evidence comparing induction of labor with expectant management in singleton pregnancies, with particular emphasis on neonatal outcomes.

PubMed, Scopus, and Web of Science were searched in March 2025. Eligible studies were parallel-group RCTs comparing induction of labor with expectant management involving at least 24 h of planned delay in singleton pregnancies. Trials addressing any gestational age or clinical indication were included. Findings were synthesized descriptively by clinical indication.

Fifty RCTs published between 1987 and 2023 were included. Indications comprised post-term pregnancy, prelabor rupture of membranes, hypertensive disorders, suspected macrosomia, elective induction at term, and preterm medical conditions. Neonatal outcomes were heterogeneously reported, most commonly NICU admission and perinatal mortality. Across indications, trials generally showed similar or improved neonatal outcomes with induction compared with expectant management in term and post-term settings, alongside comparable or reduced cesarean delivery rates. In hypertensive and preterm conditions, neonatal outcomes varied by gestational age, with higher NICU admissions reflecting prematurity.

This scoping review maps RCT evidence suggesting that induction is not associated with worse neonatal outcomes across most indications. Effects are context-specific and gestational age-dependent, with important trade-offs in preterm settings. Substantial heterogeneity and evidence gaps highlight the need for standardized outcomes and further research.