Cochrane · systematic review · CD004945
Induction of labour at or beyond 37 weeks' gestation
Middleton, P, Shepherd, E, Morris, J, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
12
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 2 · 14.3%Very low 1 · 7.1%Low 2 · 14.3%Moderate 6 · 42.9%High 3 · 21.4%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyLabour induction versus expectant management (infant/child outcomes)
Population: pregnant women at or beyond 37 weeks gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death (intrauterine deaths plus neonatal deaths in the first week of life) Labour induction vs expectant management (infant/child outcomes) | RR 0.31 [0.15, 0.64] | 22 studies · 18795 participants | High |
Stillbirth Labour induction vs expectant management (infant/child outcomes) | RR 0.3 [0.12, 0.75] | 22 studies · 18795 participants | High |
Admission to neonatal intensive care unit Labour induction vs expectant management (infant/child outcomes) | RR 0.88 [0.8, 0.96] | 17 studies · 17826 participants | High |
Neonatal encephalopathy Labour induction vs expectant management (infant/child outcomes) | RR 0.69 [0.37, 1.31] | 2 studies · 8851 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Apgar score less than 7 at 5 minutes Labour induction vs expectant management (infant/child outcomes) | RR 0.73 [0.56, 0.96] | 20 studies · 18345 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Neonatal (birth) trauma Labour induction vs expectant management (infant/child outcomes) | RR 0.97 [0.63, 1.49] | 5 studies · 13106 participants | Moderate Downgraded: risk of bias, imprecision, indirectness |
Neurodevelopment at childhood Labour induction vs expectant management (infant/child outcomes) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Labour induction versus expectant management (maternal outcomes)
Population: pregnant women at or beyond 37 weeks gestation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caesarean section Labour induction vs expectant management (maternal outcomes) | RR 0.9 [0.85, 0.95] | 31 studies · 21030 participants | Moderate Downgraded: risk of bias |
Operative vaginal birth (forceps or ventouse) Labour induction vs expectant management (maternal outcomes) | RR 1.03 [0.96, 1.1] | 22 studies · 18584 participants | Moderate Downgraded: risk of bias |
Perineal trauma (severe perineal tear) Labour induction vs expectant management (maternal outcomes) | RR 1.04 [0.85, 1.26] | 5 studies · 11589 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Postpartum haemorrhage Labour induction vs expectant management (maternal outcomes) | RR 1.02 [0.91, 1.15] | 9 studies · 12609 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Breastfeeding at discharge Labour induction vs expectant management (maternal outcomes) | RR 1 [0.96, 1.04] | 2 studies · 7487 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Postnatal depression Labour induction vs expectant management (maternal outcomes) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Length of maternal hospital stay (days) Labour induction vs expectant management (maternal outcomes) | MD 0.19 | 7 studies · 4120 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Labour induction versus expectant management (infant/child outcomes)
Population: pregnant women at or beyond term
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Perinatal death Labour induction vs expectant management (infant/child outcomes) | RR 0.33 [0.14, 0.78] | 20 studies · 9960 participants | Moderate |
Stillbirth Labour induction vs expectant management (infant/child outcomes) | RR 0.33 [0.11, 0.96] | 20 studies · 9960 participants | Moderate |
Admission to neonatal intensive care unit Labour induction vs expectant management (infant/child outcomes) | RR 0.88 [0.77, 1.01] | 13 studies · 8531 participants | Moderate |
Neonatal encephalopathy Labour induction vs expectant management (infant/child outcomes) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Apgar score less than 7 at 5 minutes Labour induction vs expectant management (infant/child outcomes) | RR 0.7 [0.5, 0.98] | 16 studies · 9047 participants | Moderate |
Neonatal trauma Labour induction vs expectant management (infant/child outcomes) | RR 1.18 [0.68, 2.05] | 3 studies · 4255 participants | Low Downgraded: imprecision |
Neurodevelopment at childhood Labour induction vs expectant management (infant/child outcomes) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Labour induction versus expectant management (maternal outcomes)
Population: women at or beyond term
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caesarean section Labour induction vs expectant management (maternal outcomes) | RR 0.92 [0.85, 0.99] | 27 studies · 11738 participants | Moderate |
Operative vaginal birth (forceps or ventouse) Labour induction vs expectant management (maternal outcomes) | RR 1.07 [0.99, 1.16] | 18 studies · 9281 participants | Moderate |
Perineal trauma Labour induction vs expectant management (maternal outcomes) | RR 1.09 [0.65, 1.83] | 4 studies · 3028 participants | Low Downgraded: imprecision |
Postpartum haemorrhage Labour induction vs expectant management (maternal outcomes) | RR 1.09 [0.92, 1.3] | 5 studies · 3315 participants | Low Downgraded: imprecision |
Breastfeeding at discharge Labour induction vs expectant management (maternal outcomes) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Postnatal depression Labour induction vs expectant management (maternal outcomes) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Length of maternal hospital stay (days) Labour induction vs expectant management (maternal outcomes) | MD 0.34 | 5 studies · 1146 participants | Very low Downgraded: imprecision, inconsistency |