title: The association between the regular use of preventive labour induction and improved term birth outcomes: findings of a systematic review and meta-analysis.
abstract: BACKGROUND
  Despite a lack of high-quality evidence, the use of 'non-indicated' term labour induction is increasingly restricted throughout the world.
  
  
  OBJECTIVE
  To assess published associations between the regular use of modelled risk-based 'non-indicated' term labour induction (hereinafter 'preventive induction') and rates of common adverse birth outcomes.
  
  
  METHODS
  MEDLINE and PUBMED databases were searched electronically.
  
  
  METHODS
  Studies were identified that compared term birth outcomes following either the current standard approach with its emphasis on the expectant management of intermediate-level risk or the regular use of preventive induction.
  
  
  METHODS
  Four studies from four unique databases were identified. A meta-analysis was performed using STATA IC12.
  
  
  RESULTS
  Pregnancies exposed to the regular use of preventive induction (n = 1153), as compared with pregnancies receiving the current standard approach (n = 1865), experienced a lower caesarean delivery rate (5.7% versus 14.4%; relative risk 0.39, 95% CI 0.31-0.50; I(2) P = 0.21), a lower neonatal intensive care unit admission rate (2.9% versus 6.5%; relative risk 0.45, 95% CI 0.31-0.65; I(2) P = 0.57), and a lower weighted adverse outcome index score (2.8 versus 6.1).
  
  
  CONCLUSIONS
  The regular use of preventive induction, as compared with the current standard approach, was associated with a more favourable pattern of birth outcomes. Other recently published meta-analyses have also determined that certain types of 'non-indicated' labour induction are beneficial. Accordingly, the current broad restrictions on 'non-indicated' labour induction should be reconsidered. Adequately powered multi-site randomised clinical trials are needed to definitively study the risks and benefits of modelled risk-based 'non-indicated' (i.e. 'preventive') term labour induction.
authors.affiliation: Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Nicholson
authors.affiliation: Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.|Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Kellar
authors.affiliation: Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: G F
authors.initials: GF
authors.lastname: Henning
authors.affiliation: Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Waheed
authors.affiliation: Department of Family and Community Medicine, McAllen Family Medicine Residency Program, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Colon-Gonzalez
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hershey Medical Center, Pennsylvania State University, Hershey, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ural
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007751:Labor, Induced; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D011247:Pregnancy; D047929:Term Birth
keywords: Active-Management-of-Risk-in-Pregnancy-at-Term (AMOR-IPAT); caesarean delivery; elective induction; neonatal intensive care unit admission; non-indicated induction; preventive induction; weighted adverse outcome index score