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Introduction: Neonatal and maternal risks increase in term pregnancy as gestational age advances and become increasingly evident post‐term. Management practices of late‐ and post‐term pregnancies vary, and the optimal time point for intervention by labor induction is yet to be determined. Material and methods: This randomized controlled trial of 381 nulliparous women with unripe cervices compared labor induction at 41+0 gestational weeks (early induction) with expectant management and labor induction at 41+5 to 42+1 gestational weeks (expectant management). This multicenter study included all five university hospitals and the largest central hospital in Finland. The study period was 2018–2022. Participants were randomized to either early induction (48.8%, n = 186) or expectant management (51.2%, n = 195) with equal randomization ratios of 1:1. This was a superiority trial, and the primary outcomes were rates of cesarean section (CS) and composite of adverse neonatal outcomes. The trial was registered at the ISRCTN registry (ISRCTN83219789, https://doi.org/10.1186/ISRCTN83219789). Results: The rates of CS (16.7% [n = 31] vs. 24.1% [n = 47], RR 0.7 [95% CI: 0.5–1.0], p = 0.07) and a composite of adverse neonatal outcomes (9.7% [n = 18] vs. 14.4% [n = 28], RR 0.7 [95% CI: 0.4–1.2] p = 0.16) did not significantly differ between the groups, but the operative delivery rate was lower in the early induction group than in the expectant management group (30.6% [n = 57] vs. 45.6% [n = 89], p = 0.003). The rates of hemorrhage ≥1000 mL and neonatal weight ≥4000 g were also lower in the early induction group, as was the vacuum extraction rate in women with vaginal delivery. Of the women with expectant management, 45.6% (n = 89) had spontaneous onset of labor. No perinatal deaths occurred, but one case of eclampsia appeared in the expectant management group. Conclusions: Offering labor induction to nulliparous women at 41+0 gestational weeks may decrease the probability of operative delivery, postpartum hemorrhage, and neonatal weight ≥4000 g. However, this study was underpowered to affirm the trends of rising rates of CS and adverse neonatal outcomes in the expectant management group. Thus, expectant management could remain an option for some, as one in two women with expectant management had a spontaneous onset of labor. [ABSTRACT FROM AUTHOR]

Introduction: Labor induction rates are increasing and, in Finland today, one of three labors is induced. Group B streptococcus (GBS) is a bacterium found in 10%–30% of pregnant women and it can be transmitted to the neonate during vaginal delivery. Although GBS is rarely harmful in the general population, it is the leading cause of severe neonatal infections such as sepsis, pneumonia, and meningitis. In addition, GBS can cause maternal morbidity. Labor induction in GBS‐positive women has not yet been investigated but concerns of infectious morbidity associated with balloon catheters have been raised. Material and methods: A historical cohort study of 1959 women undergoing labor induction by balloon catheter in Helsinki University Hospital, Finland, between January 1, 2014 and December 31, 2017. Women with viable singleton term pregnancy in cephalic presentation, unfavorable cervix (Bishop score <6), and intact amniotic membranes were included. GBS was screened by rapid qualitative in vitro test (XPert® GBS) from vaginal and perineal culture upon admission for labor induction. All women testing positive received prophylactic antibiotics. Results: Of the women, 469 (23.9%) were GBS‐positive. The rate of maternal intrapartum infection was 7.4%, being lower in the GBS‐positive group compared with the GBS‐negative group (4.7% vs 8.3%; p = 0.01). The rate of maternal postpartum infection was 3.9%, and the rate of neonatal infection was 3.3%, both being similar between the groups. Also, no difference in the rates of other adverse neonatal outcomes was seen. No GBS sepses occurred in the study. In multivariable logistic regression, rupture of membranes to delivery interval ≥12 hours was associated with maternal intrapartum and postpartum infection, as well as neonatal infection. Other risk factors for maternal intrapartum infection were GBS‐negativity, nulliparity, prolonged pregnancy (≥41 weeks), and Bishop score <3 at the start of induction. Cesarean section was associated with postpartum endometritis, while nulliparity, gestational diabetes, and maternal intrapartum infection were associated with neonatal infection. Conclusions: Regarding maternal and neonatal infectious morbidity, labor induction with balloon catheter appears safe in women colonized with GBS when prophylactic antibiotics are administered at the onset of labor or at membrane rupture. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal and maternal risks increase in term pregnancy as gestational age advances and become increasingly evident post-term. Management practices of late- and post-term pregnancies vary, and the optimal time point for intervention by labor induction is yet to be determined., Material and Methods: This randomized controlled trial of 381 nulliparous women with unripe cervices compared labor induction at 41 +0 gestational weeks (early induction) with expectant management and labor induction at 41 +5 to 42 +1 gestational weeks (expectant management). This multicenter study included all five university hospitals and the largest central hospital in Finland. The study period was 2018-2022. Participants were randomized to either early induction (48.8%, n = 186) or expectant management (51.2%, n = 195) with equal randomization ratios of 1:1. This was a superiority trial, and the primary outcomes were rates of cesarean section (CS) and composite of adverse neonatal outcomes. The trial was registered at the ISRCTN registry (ISRCTN83219789, https://doi.org/10.1186/ISRCTN83219789)., Results: The rates of CS (16.7% [n = 31] vs. 24.1% [n = 47], RR 0.7 [95% CI: 0.5-1.0], p = 0.07) and a composite of adverse neonatal outcomes (9.7% [n = 18] vs. 14.4% [n = 28], RR 0.7 [95% CI: 0.4-1.2] p = 0.16) did not significantly differ between the groups, but the operative delivery rate was lower in the early induction group than in the expectant management group (30.6% [n = 57] vs. 45.6% [n = 89], p = 0.003). The rates of hemorrhage ≥1000 mL and neonatal weight ≥4000 g were also lower in the early induction group, as was the vacuum extraction rate in women with vaginal delivery. Of the women with expectant management, 45.6% (n = 89) had spontaneous onset of labor. No perinatal deaths occurred, but one case of eclampsia appeared in the expectant management group., Conclusions: Offering labor induction to nulliparous women at 41 +0 gestational weeks may decrease the probability of operative delivery, postpartum hemorrhage, and neonatal weight ≥4000 g. However, this study was underpowered to affirm the trends of rising rates of CS and adverse neonatal outcomes in the expectant management group. Thus, expectant management could remain an option for some, as one in two women with expectant management had a spontaneous onset of labor., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: There is an ongoing debate on the optimal time of labor induction to reduce the risks associated with prolonged pregnancy., Material and Methods: Registry-based study of 212 716 term, singleton cephalic deliveries between 2006 and 2012 in Finland comparing the outcomes of labor induction with those of expectant management in five, three-day gestational age periods between 40 and 42 weeks (group 1: 40 +0 -40 +2 ; group 2: 40 +3 -40 +5 ; group 3: 40 +6 -41 +1 ; group 4: 41 +2 -41 +4 ; group 5: 41 +5 -42 +0 ). Using Poisson regression, induced deliveries in each of the gestational age periods were compared with all ongoing pregnancies. Propensity score matching was applied to reduce confounding by indication., Results: In the gestational age groups 1 and 2, labor induction significantly decreased the risk of meconium aspiration syndrome [relative risk (RR) 0.40, 95% confidence interval (CI) 0.18-0.91 (group 1), RR 0.44, 95% CI 0.21-0.91 (group 2)] but increased the risk for prolonged hospitalization of a neonate [RR 1.30, 95% CI 1.10-1.54 (group 1) and RR 1.23, 95% CI 1.03-1.47 (group 2)]. In groups 3 and 4, labor induction significantly increased the risk for emergency cesarean section [RR 1.17, 95% CI 1.06-1.28 (group 3) and RR 1.19, 95% CI 1.09-1.29 (group 4)] but still reduced the risk for meconium aspiration syndrome. In group 5, labor induction did not affect the risk for any of the studied outcomes (operative delivery, obstetric trauma, neonatal mortality, respirator treatment, Apgar <7)., Conclusions: Propensity score matching is a novel approach to studying the effect of labor induction. It highlighted the conflicting maternal and neonatal risks and benefits of the intervention, and supported expectant management as a valid option, at least until close to 42 weeks., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objectives: To describe labor outcomes in women with prolonged pregnancy and induction of labor with a Foley catheter, as compared with women with spontaneous onset of labor., Design: Retrospective study., Setting: Helsinki University Hospital., Sample: 553 women with uncomplicated prolonged pregnancies between January 2011 and January 2012, divided into 303 women (54.8%) with Foley catheter induction and 250 (45.2%) with spontaneous labor., Methods: Maternal and neonatal characteristics of women with uncomplicated singleton pregnancy of ≥41(+5) weeks of gestation were analyzed., Main Outcome Measures: Cesarean delivery rates, maternal and neonatal morbidity., Results: The cesarean delivery rate was 30.7% (n = 93/303) in women with labor induction and 4.8% (12/250) in women with spontaneous onset of labor (p < 0.001). The cesarean delivery rate was 37.3% (91/244) among nulliparous women with labor induction and 8.7% (11/126) among women with spontaneous labor, a sixfold increased risk (odds ratio 6.2). Among parous women, cesarean section rates were low and not significantly different (3.4% vs. 0.8%, p = 0.2). There were no differences in maternal intrapartum or postpartum infection rates or adverse neonatal outcomes between the groups., Conclusions: Foley catheter induction of labor in prolonged pregnancy did not increase maternal or perinatal morbidity compared with spontaneous onset of labor but was associated with a considerably increased cesarean section rate, particularly among nulliparous women., (© 2015 Nordic Federation of Societies of Obstetrics and Gynecology.)