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Sir,

We read with great interest the commentary by Menticoglou and Hall published in May 2002 and want to echo the point of increasing caesarean section rate as a result of this nonsensus consensus. Our unit has adopted the practice of routine induction of labour at 41 weeks of gestation for several years on the basis of the findings of the Cochrane Review1, which suggested that this approach can reduce perinatal mortality. Women are admitted to the hospital at 41 weeks of gestation for cervical assessment with the Bishop's score and induction of labour. If the cervix is favourable, combined induction of labour with artificial rupture of membranes and oxytocin infusion is performed on the following morning. If the cervix is unfavourable, a vaginal prostaglandin E2 3-mg tablet is used to prime the cervix. Combined induction is performed on the following morning if the cervix becomes favourable. If not, another dose of vaginal prostaglandin is given and induction is delayed for another day. In the case of labour occurring after cervical priming with vaginal prostaglandin, it is counted as induction of labour.

We have analysed the caesarean section rate for nulliparae undergoing induction of labour at 41 weeks of gestation from our hospital obstetric database. In the year 2000, 183 nulliparous women were induced under this consensus and 59 of them (32.2%) had caesarean sections. This caesarean section rate was significantly higher than that for term, singleton, vertex presenting fetuses in nulliparous women in the same year (excluding those 183 women with induction at 41 weeks), which was 368/2271 or 16.2% (χ2 test, P < 0.0001). More alarming is that the caesarean section rate for nulliparous women undergoing induction of labour at 41 weeks of gestation increased even further to 35.0% (63/180) in the year 2001 and 41.1% (23/56) in the current year (January to May).

We agree with the authors that it is now time to reconsider the consensus on routine induction of labour at 41 weeks of gestation, particularly in nulliparous women.

Reference

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  • 1
    Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term [Cochrane review]. The Cochrane Library, 1. Oxford : Update Software, 2002.