(632) Immediate Induction Versus Expectant Management in Primiparas Presenting with Decreased Fetal Movements at 39 Weeks

To evaluate maternal and neonatal outcomes in primiparous patients presenting with a subjective complaint of decreased fetal movements (DFM), comparing those who underwent immediate labor induction to those who declined and were managed expectantly.


Study Design:

This retrospective cohort study included nulliparous patients with singleton pregnancies who presented to our obstetric triage unit between 39+0 and 39+6 weeks of gestation with a subjective complaint of DFM, a reassuring fetal assessment, a normal biophysical profile, and an amniotic fluid index (AFI) >50 mm. In accordance with departmental protocol, patients were offered labor induction. Those who agreed formed the induction group, while those who declined and were discharged home comprised the control group. Labor induction was guided by the Bishop score: patients with a score < 8 underwent cervical ripening using a balloon catheter or dinoprostone, while those with a score≥8 received oxytocin. Maternal and neonatal outcomes were compared between groups.

 


Results:

A total of 413 patients were included: 282 in the induction group and 131 in the expectant management group. Baseline characteristics were comparable. Delivery week was earlier in the induction group (39.4±0.3 vs. 40.1±0.3 weeks, p< 0.001). No significant differences were observed in birthweight (p=0.945), cesarean delivery rates (p=0.683) or NICU admission (p=0.696). The induction group had significantly fewer neonates with cord pH < 7.15 (2.5% vs. 6.9%, p=0.001), and neonatal hospitalization (days) was slightly shorter (2.0±0.2 vs. 2.3±0.5 days, p=0.034). Total maternal hospitalization duration was significantly longer in the induction group (3.6±0.6 vs. 2.2±0.5 days, p< 0.001), though postpartum stay was shorter (2.0±0.2 vs. 2.2±0.1 days, p< 0.001).

 

Conclusion:

Among primiparous patients presenting with DFM between 39+0 and 39+6 weeks, immediate labor induction was associated with earlier delivery and improved umbilical cord pH without increasing maternal or neonatal complications. Findings support considering induction; randomized trials are warranted.