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Routine induction of labour at 41 weeks gestation: nonsensus consensus
Author(s) -
Menticoglou Savas M.,
Hall Philip F.
Publication year - 2002
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2002.01004.x
Subject(s) - obstetrics and gynaecology , medicine , library science , citation , obstetrics , family medicine , gynecology , pregnancy , biology , genetics , computer science
Traditionally pregnancy has been considered ‘post-term’ at 42 completed weeks of gestation. At this gestation, if the cervix is unfavourable, debate over best practice has been between routine induction of labour and expectant management with some form of serial fetal monitoring. Popular wisdom seems to be that meta-analysis of the available randomised controlled trials has settled the question in favour of routine induction. The largest included trial, containing over half the cases (n 1⁄4 3407), was carried out in Canada and published in 1992. The results of the meta-analysis led the Society of Obstetricians and Gynaecologists of Canada (SOGC) to issue Clinical Practice Guidelines in 1997. The guidelines recommended that: 1. after 41 completed weeks of gestation, if the dates are certain, women should be offered elective delivery; 2. if the cervix is unfavourable, ripening should be undertaken; and 3. if expectant management is chosen, assessment of fetal health should be initiated. It is presumed that randomised controlled trials or, even better, meta-analyses of randomised trials, provide the best evidence to determine appropriate care. However, once information has been declared ‘the best available evidence’, particularly if that assertion is used to justify clinical practice guidelines or ‘consensus’, further inquiry may be inhibited. Since it is implied that ‘the answers are all in’, mutation from clinical practice guideline to standard of care is prompt and uncomplicated, particularly if the labels ‘consensus’ or ‘policy statement’ are used between the two as conceptual mutagens. The standard of care in Canada now is assumed to be routine induction at 41 weeks. This commentary is intended to give pause to those who have accepted and adopted this standard.