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IN THE LITERATURE: Elective Induction, Selective Deduction, and Cesarean Section

Authors

  • Marc J. N. C. Keirse MD, DPhil, DPH, FRCOG, FRANZCOG

    1. Marc Keirse is Professor of Obstetrics and Gynaecology at Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.
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  • COMMENTARY ON:
    Caughey AB, Sundaram V, Kaimal AJ, Gienger A, Cheng YW, McDonald KM, Shaffer BL, Owens DK, Bravata DM. Systematic review: Elective induction of labor versus expectant management of pregnancy. Ann Intern Med 2009;151:252-263.

Address correspondence to Marc J.N.C. Keirse, Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders University, Flinders Medical Centre, Bedford Park, SA 5042, Australia.

Abstract

Abstract:  A recent systematic review found no “good quality evidence” that elective induction of labor confers substantial benefits to either mothers or babies, but concluded that elective induction is associated with a decreased risk of “cesarean delivery.” Admittedly, elective induction was qualified as “at 41 weeks of gestation and beyond” with 42 weeks being proclaimed as the cutoff point between “elective” and “medically indicated.” Major predictors of the success of any induction and the subsequent mode of delivery, such as parity and cervical status, were not taken into account. Crucial boundaries between what is elective and what is selective, what is medically indicated and what is not, and what is maternal request or persuasive coercion, remain as vague as ever. (BIRTH 37:3 September, 2010)

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