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Thread: Induce Everyone at 39 weeks = Better Outcomes

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    Induce Everyone at 39 weeks = Better Outcomes

    I put this in debates since it is a pretty controversial topic.

    ACOG (American college of obstetrics & gyncology) put out a concensus statement at their annual meeting in support of elective induction at 39 weeks for all pregnancies with good dating.

    Contemporary OB/GYNObstetrics-Gynecology & Women's HealthACOG annual meeting 2016
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    Why not induce everyone at 39 weeks?
    May 17, 2016 By Gretchen L Schwenker, PhD
    In a debate presented at the 2016 annual meeting of the American College of Obstetricians and Gynecologists (ACOG), “If no elective inductions before 39 weeks, why not induce everyone at 39 weeks,” Dr Charles Joseph Lockwood, MD, MHCM, and Errol Raymond Norwitz, MD, PhD, weighed in on the subject with their respective points of view.

    Also serving as the Edith Louise Potter Memorial Lecture, the debate took place on Monday, May 16th, at the ACOG meeting.

    Dr Lockwood commented to Contemporary OB/GYN on the feasibility and safety of induction at 39 weeks, noting that the background population rate of stillbirths climbs from 36 weeks to more than 42 weeks.

    “Fetal macrosomia,” he explained, “also increases after 39 weeks, which can increase the infant’s risk of shoulder dystocia and the maternal risk of C-section. In addition, maternal complications like preeclampsia occur at 40 and 41 weeks. Thus, induction at 39 weeks could potentially reduce all of these risks, but the induction could be associated with a higher rate of C-section.”

    Dr Lockwood also remarked that the current literature “is equivocal and not easily applied to the general OB population.” He noted that a clinical trial addressing these issues would need to include millions of patients.

    At the debate, Dr Lockwood provided a Monte Carlo microsimulation model by USF researchers. He outlined it as follows:

    · Overall, when taking into account all outcomes and preferences, elective induction of labor during the 39th week (eIOL-39) is always a superior decision strategy to the current practice of expectant management (EM) with IOL at the end of the 41st week (EM with IOL-41).

    · Optimal maternal age for delivery is about 29 or 30 years.

    · In comparison to EM with IOL-41, eIOL-39 reduces number of cesarean deliveries, stillbirths, and severe complication rates for both infant and mother.

    · Neonatal and maternal mortality is not different between eIOL-39 and EM with IOL-41 strategy.

    · Maternal age, preferences for mother’s health versus baby’s health, and morbidity weighting did not meaningfully affect results.

    Dr Norwitz commented to Contemporary OB/GYN that “My position is 39 weeks and Out!” He went on to explain further: “There is no benefit to the fetus waiting beyond 39 weeks in well-dated pregnancies. Continued EM is associated with risks to the fetus of stillbirth, neurodevelopmental injury, etc. If a baby is born at 39 weeks, it is not at risk of stillbirth at 40 weeks.”

    But what about the mother? Dr Norwitz responded that there is “no increased risk of cesarean in multiparas and nulliparas with a favorable cervix.” He concluded that “it probably does increase risk of cesarean for nulliparas with an unfavorable cervix, but given the newer cervical ripening agents, the risk is small.”

    Both participants, Dr Lockwood and Dr Norwitz, reviewed the literature on this topic.

    Dr Lockwood is Dean of Morsani College of Medicine, University of South Florida, Tampa, and Senior Vice President of USF Health. Dr Norwitz is Louis E. Phaneuf Professor of Obstetrics & Gynecology, Tufts University School of Medicine, and Chairman, Department of Obstetrics & Gynecology at Tufts Medical Center, Boston, Massachusetts.
    Why not induce everyone at 39 weeks? | Contemporary OB/GYN

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    If the literature is ambiguous and not applicable to current OB populations I'd fall on the side of not making this the standard of care. But, I'm not against more research into it. It's good to know when interventions hurt (elective induction befor 39 weeks) and when they would help.
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    I find it interesting she states the optimal age for delivery is 29/30. I always thought it was ideal to be under 25.
    Last edited by the_lepus; 05-24-2016 at 08:25 PM. Reason: typo

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    Quote Originally Posted by the_lepus View Post
    I find it interesting she states the optimal age for delivery is 29/30. I always thought it was ideal to be under 25.
    I thought that was interesting too, especially because my most recent delivery (baby 4 at age 31) was my best experience, which was a huge surprise to me.

    As for the rest of it, I do think the "we won't induce until 41 weeks" thing is a bit rigid, and letting up on that policy a bit is probably a good thing. But then I do think it could lead to women feeling pressured into inducing as well, when it isn't really what they want. So I dunno.
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    the age thing is interesting.. all of mine were fine, and I had them at 24, 30, 36 and 38. Didn't really have a bad experience, none of them were hard.

    As far as the induction, I really think it just depends on the individual. I was induced for the last one, because of my age (38), and I had gestational diabetes. Even with the induction my delivery was perfectly fine. I didn't have any extra pains, and it still was as easy as all my others.

    To make it a standard that everyone should get induced at 39 weeks is a bit much, it should just be based on the individual, as not all pregnancies are alike, nor are all women's bodies.

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