German investigators explored the relationship between labor induction and fetal death between 2005 and 2012 in 5,300,000 births in order to determine whether a policy of late term induction decreased fetal death rates.
The induction rate rose over the time period from 17% to 22% of all deliveries (induction rate in women who labored not reported). The mean gestational age at induction fell from 41 weeks 0 days in 2005 to 39 weeks 5 days by 2009 and remained stable thereafter; however, the fetal death rate in singleton, normally formed babies in pregnancies reaching full-term (37 wks) increased over the time period in both induced and non-induced pregnancies.
The investigators comment that if fetal death rates rise after 41 weeks 0 days, then inducing labor at this time should produce a decline, but their analysis failed to find this correlation. They point to the many factors associated with increased risk of fetal death, which make it difficult to calculate the likelihood of this rare event for any individual woman, and conclude:
In the absence of solid understanding of all risk factors for [fetal death], an intervention which may lack . . . proof to be more beneficial . . . than to “watch and wait,” like routine liberal use of [induction of labor] in healthy term women, should be [weighed] carefully for potential harm and benefit. Our data analysis does not support . . . term [induction of labor] in healthy women.
