Summary of findings 1. Labour induction versus expectant management (infant/child outcomes).
| Induction of labour for improving birth outcomes for women at or beyond 37 weeks gestation | ||||||
| Population: pregnant women at or beyond 37 weeks gestation Setting: Austria, Canada, China, India, Finland, Malaysia, Netherlands, Norway, Russia, Spain, Sweden, Thailand, Tunisia, Turkey, UK and USA Intervention: labour induction Comparison: expectant management | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with expectant management | Risk with labour induction | |||||
| Perinatal death (intrauterine deaths plus neonatal deaths in the first week of life) | Study population | RR 0.31 (0.15 to 0.64) | 18,795 (22 RCTs) | ⊕⊕⊕⊕ HIGH1 | Exact day of death not reported for all of the nine neonatal deaths but all were likely to have occurred in the first week of life (see Table 2) | |
| 3 per 1000 | 0.4 per 1000 (0.1 to 1.9) |
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| Stillbirth | Study population | RR 0.30 (0.12 to 0.75) | 18,795 (22 RCTs) | ⊕⊕⊕⊕ HIGH1 | ||
| 2 per 1000 | 1 per 1000 (0.15 to 1.5) | |||||
| Admission to neonatal intensive care unit | Study population | RR 0.88 (0.80 to 0.96) | 17,826 (17 RCTs) | ⊕⊕⊕⊕ HIGH1 | ||
| 95 per 1000 | 83 per 1000 (80 to 91) | |||||
| Neonatal encephalopathy | Study population | RR 0.69 (0.37 to 1.31) | 8,851 (2 RCTs) |
⊕⊕⊝⊝ LOW 2 |
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| 5 per 1000 | 3 per 1000 (2 to 7) |
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| Apgar score less than 7 at 5 minutes | Study population | RR 0.73 (0.56 to 0.96) | 18,345 (20 RCTs) | ⊕⊕⊕⊝ MODERATE3 | ||
| 13 per 1000 | 10 per 1000 (7 to 12) | |||||
| Neonatal (birth) trauma | Study population | RR 0.97 (0.63 to 1.49) | 13,106 (5 RCTs) | ⊕⊕⊕⊝ MODERATE4 | ||
| 7 per 1000 | 7 per 1000 (5 to 12) | |||||
| Neurodevelopment at childhood follow‐up | Study population | ‐ | (0 RCTs) | ‐ | No RCTs reported data for this outcome. | |
| see comment | see comment | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1Not downgraded (larger studies (> 1000 participants) are generally at low risk of bias, although some smaller studies have unclear risk of selection bias); not downgraded for lack of blinding as unlikely to have influenced objective outcomes.
2Downgraded 2 levels for very serious concerns regarding imprecision (wide confidence intervals crossing the line of no effect).
3Downgraded 1 level for serious concerns regarding indirectness, with three studies reporting Apgar scores with more stringent cutoffs than < 5 at 7 minutes (see graph footnotes).
4Downgraded 1 level for serious concerns regarding imprecision, with wide confidence intervals crossing line of no effect.