When is the fetus better off outside the mother’s uterus, and if so, how should that be brought about?
Abstract: Smith (2003) found unexplained stillbirth occurs once in 2000 births (0.5/1000) after 34 weeks among low risk second pregnancies, following a first vaginal birth in the absence of induction for postdates. If induction for postdates could prevent stillbirth by expediting the deliver, one would expect to save 0.5/1000. Four systematic reviews performing meta-analysis of the data regarding the effect of induction for postdates draw three different conclusions. Cochrane (2012) concludes that inducing at 41 weeks can prevent 1 stillbirth/perinatal death for every 410 inductions or 2.5/1000 perinatal deaths, a number exceeding the rate of unexplained stillbirth at term without induction. Hussain (2011) looking at inductions after 41 weeks concludes that performing inductions at 41 weeks does not prevent stillbirth but does prevent 1 perinatal death in the first week of life for every 650 inductions (1.5/1000) performed. None of the studies look at mortality after 7 days. Therefore it is not known whether those ‘saved’ babies die after the one week mark. Wennerholm (2009) and Sanchez-Ramos (2003) look at the same data for inductions after 41 weeks and found no evidence supporting induction for postdates, stating, that induction for postdates is not supportable from a scientific point of view. There is limited and inconsistent data suggesting that induction might improve outcomes in the cases of: Postdates, Oligohydramnios, Suspected worsening of fetal anomaly at 34-39 weeks, Fetal Demise, Multiple gestation with fetal death, Poorly controlled diabetes, Hypertension at 38-39 weeks, Maternal Chronic Pulmonary disease, Maternal Chronic Renal disease, Intrahepatic cholestasis of pregnancy, Mild (after 37 weeks) or Severe (after 34 weeks) preeclampsia, Isoimmunization, and Premature rupture of membranes- after 34 week. There is a complete lack of research evidence suggesting that induction improves outcomes in the case of: History of unexplained stillbirth after 39 weeks, logistical such as distance from hospital or risk of precipitous labor, Antiphospholipid antibody, severe growth restriction or chorioamnionitis. Consistent reliable evidence is lacking for all justifications for induction.