The average age of women at childbirth in industrialized nations has been increasing steadily for approximately 30 years. The risks of perinatal death, hypertensive disease, gestational diabetes mellitus, placenta previa, and placental abruption are higher among women aged 35 years or older than among younger women. Although induction of labor may reduce the risk of stillbirth, it also may increase the risk of cesarean delivery, which is common in this group. A multicenter, randomized, controlled trial was conducted comparing the rate of cesarean section between women assigned to induction of labor between 39 weeks 0 days and 39 weeks 6 days of gestation and those assigned to expectant management. Eligible women were nulliparous, were aged 35 years or older on their expected due date, and had a singleton live fetus in a cephalic presentation. The primary outcome was cesarean delivery. A total of 619 of 4542 women who were eligible to participate in the trial (14%) underwent randomization. Among the 46% of eligible nonparticipants who expressed a preference for one of the management strategies, 1595 (88%) of 1804 women preferred expectant management.
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