Intended for healthcare professionals


Optimising the management of late term pregnancies

BMJ 2019; 364 doi: (Published 20 February 2019) Cite this as: BMJ 2019;364:l681

Linked Research

Induction of labour at 41 weeks versus expectant management until 42 weeks

Linked BMJ Opinion

To induce or not to induce pregnant women at 41 weeks

  1. Sara Kenyon, professor of evidence based maternity care1,
  2. Magdalena Skrybant, patient and public involvement and engagement lead for NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands1,
  3. Tracey Johnston, consultant in fetal maternal medicine2
  1. 1Institute of Applied Health Research, Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham B15 2TT, UK
  2. 2Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
  1. Correspondence to: S Kenyon S.Kenyon{at}

Inconclusive evidence and high induction rates affect quality of care for women

Decisions around labour and birth are extremely important for most pregnant women. To help them make informed decisions, women need clear, accurate information based on the best available evidence. This is especially true “post-term,” when risks for women and their babies are increased.

Pregnancy is defined as at term from 37+0 to 42+0 weeks of gestation. Most women have given birth by 42 weeks, with 10% going over and becoming post term.1 The risk of perinatal death is increased from 42 weeks, and induction of labour is offered to avoid this risk, although the exact timing after 40 weeks varies within Europe.1 A recent Cochrane systematic review,2 which included 30 randomised trials and more than 12 000 women, found that a policy of induction at or beyond the expected date of birth (usually after 41 weeks) compared with expectant management was associated with fewer perinatal deaths, neonatal admissions to intensive care, and caesarean sections but more operative vaginal births. The review highlighted the …

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