Induction at or before 40 weeks

Pre-emptive induction of labour, where women with uncomplicated pregnancies were routinely offered induction at or before 40 weeks, was practised in some obstetric units in some countries in the 1970s. Six randomized trials compare a policy of 'routine' induction at 39 weeks [64,65], or 40 weeks [66-69], with either 'expectant' management of an indefinite duration or expectant management until 42 weeks' gestation. These trials reveal no evidence of any major benefit or risk to 'routine' induction at 40 weeks. Two perinatal deaths of normally formed babies occurred in the expectant arm of these trials and none in the induction arm. Obviously, this is not a significant difference. There was no effect on Caesarean section (odds ratio 0.60 95% CI 0.35-1.03), instrumental delivery or use of analgesia in labour. Not surprisingly, given the relationship between gestational age and meconium staining of the amniotic fluid in labour, induction around 40 weeks reduces the incidence of meconium staining in labour (odds ratio 0.50 (0.31-0.86). Unfortunately, the authors of these trials did not address the important question of women's views of induction of labour at this stage of pregnancy. The authors of these trials missed a golden opportunity in failing to measure women's satisfaction with their care. 'Routine' induction of labour at 40 weeks would no longer be considered a realistic option for the prevention of post-term pregnancy. The number of inductions at 40 weeks required to prevent an adverse outcome at 41 or 42 weeks would be excessive and intervention at this level would be unlikely to be welcomed by women, obstetricians or midwives.

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Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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