A Randomized Trial of Induction Versus Expectant Management

This study was a randomized trial of 6106 pregnant participants randomized at 38 weeks gestation to either elective induction of labor at 39 weeks gestation or expectant management. The primary research question was does elective induction of labor in nulliparous women at 39 weeks improve perinatal outcome compared with expectant management? Women in the induction group were assigned to undergo induction of labor at 39 weeks 0 days to 39 weeks 4 days. Women in the expectant management group were asked to forego elective delivery before 40 weeks 5 days and to have delivery initiated no later than 42 weeks 2 days. The primary outcome was a composite of perinatal death or severe neonatal complications. There was not a statistically significant difference in the frequency of the primary outcome between groups. There was a significantly lower frequency of cesarean delivery, the principal secondary outcome, in the induction group than in the expectant management group.