{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T06:20:00Z","timestamp":1785565200584,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>This study aimed to assess whether induction of labor at 41\u2009weeks of gestation improved perinatal outcomes in a low\u2010risk pregnancy compared with expectant management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>Registry\u2010based national cohort study in The Netherlands. The study population comprised 239\u2009971 low\u2010risk singleton pregnancies from 2010 to 2019, with birth occurring from 41+0 to 42+0\u2009weeks. We used propensity score matching to compare induction of labor in three 2\u2010day groups to expectant management, and further conducted separate analyses by parity. The main outcome measures were stillbirth, perinatal mortality, 5\u2010min Apgar &lt;4 and\u2009&lt;7, neonatal intensive care unit (NICU) admissions \u226524\u2009h, and emergency cesarean section rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared with expectant management, induction of labor at 41+0 to 41+1\u2009weeks resulted in reduced stillbirths (adjusted odds ratio [aOR] 0.15, 95% confidence interval [CI] 0.05\u20130.51) in both nulliparous and multiparous women. Induction of labor increased 5\u2010min Apgar score\u2009&lt;7 (aOR 1.30, 95% CI 1.09\u20131.55) and NICU admissions \u226524\u2009h (aOR 2.12, 95% CI 1.53\u20132.92), particularly in nulliparous women, and increased the cesarean section rate (aOR 1.42, 95% CI 1.34\u20131.51). At 41+2\u201341+3\u2009weeks, induction of labor reduced perinatal mortality (aOR 0.13, 95% CI 0.04\u20130.43) in both nulliparous and multiparous women. The rate of 5\u2010min Apgar score\u2009&lt;7 was increased (aOR 1.26, 95% CI 1.06\u20131.50), reaching significance in multiparous women. The cesarean section rate increased (aOR 1.57, 95% CI 1.48\u20131.67) in both nulliparous and multiparous women. Induction of labor at 41+4 to 41+5\u2009weeks reduced stillbirths (aOR 0.30, 95% CI 0.10\u20130.93). Induction of labor increased rates of 5\u2010min Apgar score\u2009&lt;4 (aOR 1.61, 95% CI 1.01\u20132.56) and NICU admissions \u226524\u2009h (aOR 1.52, 95% CI 1.08\u20132.13) in nulliparous women. Cesarean section rate was increased (aOR 1.47, 95% CI 1.38\u20131.57) in nulliparous and multiparous women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At 41+2 to 41+3\u2009weeks, induction of labor reduced perinatal mortality, and in all 2\u2010day groups at 41\u2009weeks, it reduced stillbirths, compared with expectant management. Low 5\u2010min Apgar score (&lt;7 and\u2009&lt;4) and NICU admissions \u226524\u2009h occurred more often with induction of labor, especially in nulliparous women. Induction of labor in all 2\u2010day groups coincided with elevated cesarean section rates in nulliparous and multiparous women. These findings pertaining to the choice of induction of labor vs expectant management should be discussed when counseling women at 41\u2009weeks of gestation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14536","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T05:40:33Z","timestamp":1678772433000},"page":"612-625","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Does induction of labor at 41\u2009weeks (early, mid or late) improve birth outcomes in low\u2010risk pregnancy? A nationwide propensity score\u2010matched study"],"prefix":"10.1111","volume":"102","author":[{"given":"Anita C. J.","family":"Ravelli","sequence":"first","affiliation":[{"name":"Department of Medical Informatics AmsterdamUMC Location University of Amsterdam  Amsterdam The Netherlands"},{"name":"Department of Obstetrics and Gynecology AmsterdamUMC Location University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Public Health Research Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris A. M.","family":"van der Post","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology AmsterdamUMC Location University of Amsterdam  Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction and Development Research Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christianne J. 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