2.3 Meta-analyses on elective induction. There have been four meta-analyses in which researchers 4 combined all of the results from randomised trials comparing expectant management to elective induction at 41-42 weeks, as well as two recently published meta-analyses that compare ri expectant management to elective induction, regardless of in tional age. The perinatal mortality results of the meta analyses differ, depending on which randomised trials were of the five meta-analyses that examined perinata death found a lower risk of perinatal death in the induction group w compared to the expectant management group 38.39 two found no relationship and one came close to reaching statistical significance (p .05
In one meta-analysis, out of approximately 7400 women there h were 13 perinatal deaths in the expectant management group and one death in the induction group.st he causes of death included in cord complication, meconium aspiration syndrome (2 cases) unexplained intrauterine foetal demise (2 cases). brain damage due to hypoxia, true knot in the cord, gestational diabetes meconium aspiration after a mother refused an ndicated induction due to poor foetal testing results, congenital anomaly (3 cases), and pneumonia The majority of the trials in which these deaths took place were conducted in the 1980s-1990s Researchers calculated that based on these data, there would need to be 328-410 elective inductions at 41 weeks to prevent one perinatal death Five out of five meta-analyses that looked at Caesarean rates found a slightly lower Caesarean rate in women assigned to labour w nduction at 41 or 42 compared to women assigned to Ca expectant 9.10.36.37.39 Women in induction groups management. also had lower rates of Caesarean for non-reassuring foetal heart rates during labour 36 However, the decrease in Caesarean rates was almost exclusively due to one study, the Hannah Post Term tria .40 When Wennerholm et al. conducted a sensitivity analysisand Table 1 Hannah post term trial results using intent-to analysis, as well as taking into accou Randomly assigned to labour overall Caesarean rate (inten Actually had