Can labor be induced at 37 weeks and 5 days of gestation?

From the Guidelines

Inducing labor at 37 weeks and 5 days is recommended for women with gestational hypertension or mild pre-eclampsia, as it is associated with improved maternal outcomes. This gestational age is considered early term, and the risks of induction at this stage are generally acceptable, especially when medically indicated 1. Common medical indications for induction at this stage include preeclampsia, gestational diabetes, intrauterine growth restriction, or other maternal or fetal conditions that make continuing the pregnancy riskier than delivery.

The decision to induce labor should be based on the individual's specific medical situation, taking into account factors such as fetal wellbeing, gestational age, and the type of hypertensive disorder 1. The induction process typically involves cervical ripening methods, followed by oxytocin administration if needed. It's essential to weigh the benefits and risks of induction, including the potential for slightly higher risks of cesarean delivery compared to spontaneous labor, particularly if the cervix is not favorable (low Bishop score) 1.

Key considerations for inducing labor at 37 weeks and 5 days include:

• The baby's lungs are typically mature by 37 weeks, but there may be slightly higher risks of respiratory issues compared to babies born at 39-40 weeks 1.
• Fetal growth restriction (FGR) is another condition where induction at 37 weeks may be recommended, especially if the umbilical artery Doppler shows decreased diastolic flow or if the estimated fetal weight is less than the 3rd percentile 1.
• The mode of delivery in pregnancies complicated by FGR should be individualized, but cesarean delivery may be recommended in cases with abnormal umbilical artery Doppler findings 1.

Ultimately, the decision to induce labor at 37 weeks and 5 days should be made jointly between the pregnant person and their healthcare provider, after discussing the specific medical situation, risks, and benefits 1.

From the Research

Induction of Labor at 37 Weeks + 5 Days

• The provided studies do not directly address the induction of labor at 37 weeks + 5 days 2, 3, 4, 5, 6.
• However, study 6 discusses the induction of labor at or beyond 37 weeks' gestation, comparing a policy of labor induction with a policy of awaiting spontaneous labor indefinitely.
• The study found that a policy of labor induction was associated with fewer perinatal deaths and stillbirths compared to expectant management 6.
• It is essential to note that the American College of Obstetricians and Gynecologists (ACOG) recommends that induction of labor should not be performed before 39 weeks of gestation without a medical indication 2.
• Study 3 and 4 discuss the use of misoprostol for labor induction in women with premature rupture of membranes beyond 36 weeks' gestation, but do not specifically address induction at 37 weeks + 5 days.
• Study 5 compares oxytocin and oral misoprostol for induction of labor in pregnant women with term prelabor rupture of membranes, but also does not address induction at 37 weeks + 5 days.

Methods of Induction

• Study 2 recommends a combination of 60- to 80-mL single-balloon Foley catheter for 12 hours and either 25-μg oral misoprostol or oxytocin infusion for induction of labor.
• Study 3 and 4 discuss the use of misoprostol for labor induction, while study 5 compares oxytocin and oral misoprostol.

Risks and Benefits

• Study 6 found that a policy of labor induction was associated with fewer perinatal deaths, stillbirths, and NICU admissions, but may make little or no difference in terms of caesarean sections, operative vaginal births, and perineal trauma.
• The studies do not provide direct evidence on the risks and benefits of induction of labor at 37 weeks + 5 days specifically.