In a horribly tragic irony, a Swedish study on managing healthy pregnancies beyond the usual 40-week term was cancelled after only a quarter of the target number of expectant mothers had been surveyed due to five stillbirths and one early death of the babies of women allowed to continue into the 43rd week of pregnancy.
The study had originally planned to survey the outcomes of 10 000 women whose pregnancy had gone beyond their due dates. Despite the clear ramifications for women, the findings were only published a year after the study was halted.
In the UK, the NHS routinely offers induction at 42 weeks, but one in 5 women give birth after 41 weeks without medical intervention. Recent American research favours induction at 40 weeks.
NICE acknowledges that pregnancies continuing after term run a higher risk of fetal compromise and stillbirth. It recognises that there is no way to identify which pregnancy is at higher risk than another and that estimated gestation (length of pregnancy), is often just that – an estimate, based on information from the expectant mother and an a scan taken halfway through the pregnancy. This is the basis for any future decision about induction of labour. So, why take the risk?
I have recently obtained admissions of liability in two cases where the pregnancies went beyond 41 weeks. Over the years, I have been instructed in several others and secured compensation for the families concerned. These cases all have several common features:-
- The pregnancy was healthy until 40 weeks
- At 41 weeks there was a discussion with the community midwife about induction of labour
- There was a membrane sweep at some point between 41 and 42 weeks
- Admission to hospital for induction of labour did not take place until 42 weeks or beyond
- The baby was born with catastrophic injuries, or died shortly after birth
The researchers involved in the Swedish study have finally confirmed that their research may lead to 'a change of the clinical guidelines to recommend induction of labour no later than at 41 + 0 gestational weeks'. The hospital leading the study has announced that it is changing its guidelines to offer induction of labour as soon as it possibly can.
Hopefully, NICE will also consider these findings a priority and provide revised guidance to hospitals and community midwifery services so that they can offer the choice of earlier induction of labour and reduce the risk of these devastating and preventable injuries.