Trial reportObstetrics and gynecology2020
Cost of Elective Labor Induction Compared With Expectant Management in Nulliparous Women.
Trial report in Obstetrics and gynecology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.
- Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline.The Journal of clinical endocrinology and metabolism · 2025Guideline
- Comparison between kinesiotherapy and usual care during the first stage of labour in misoprostol-induced pregnant women: randomised clinical trial.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025Trial
- Labor induction at 41Acta obstetricia et gynecologica Scandinavica · 2024Trial
- Comparing Costs to the Public Healthcare System Between Induction of Labor and Expectant Management, Stratified by Parity and Gestation: An Australian Population-Based, Retrospective Cohort Study.Birth (Berkeley, Calif.) · 2026Article
- Pharmacologic cervical ripening strategies and time-related outcomes: a community hospital cohort study.AJOG global reports · 2026Article
- Assessing the impact of indication for labor induction on delivery outcomes: a five-year cohort study.BMC pregnancy and childbirth · 2026Article
- Beyond evidence hierarchies: Leveraging randomized controlled trials and real-world data to advance the value of maternity care.Acta obstetricia et gynecologica Scandinavica · 2026Review
- Clinical examination for identifying low-risk pregnancies suitable for expectant management beyond 40-41 gestational weeks: maternal and fetal outcomes.Archives of gynecology and obstetrics · 2025Article
- Perinatal mortality and other severe adverse outcomes following planned birth at 39 weeks versus expectant management in low-risk women: a population based cohort study.EClinicalMedicine · 2025Article
- Review
- Source of variation in cost of obstetrical care for low-risk nulliparas at term.American journal of obstetrics and gynecology · 2024Article
- Gestational Age and Birth Outcomes in Term Singleton Pregnancies Conceived With Infertility Treatment.JAMA network open · 2023Article
- Outpatient vs inpatient induction of labor with oral misoprostol: A retrospective study.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non-Medically Indicated Induction of Labor at 39 Weeks.JAMA network open · 2023Article
- Cost-effectiveness analysis of induction of labour at 41 weeks and expectant management until 42 weeks in low risk women (INDEX trial).European journal of obstetrics & gynecology and reproductive biology: X · 2023Article
- Effects of maternal age on the mode of delivery following induction of labor in nulliparous term pregnancies: A retrospective cohort study.Health science reports · 2022Article
- Directly Measured Costs of Severe Maternal Morbidity Events during Delivery Admission Compared with Uncomplicated Deliveries.American journal of perinatology · 2022Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
Abstract
objectiveTo compare the actual health-system cost of elective labor induction at 39 weeks of gestation with expectant management.
methodsThis was an economic analysis of patients enrolled in the five Utah hospitals participating in a multicenter randomized trial of elective labor induction at 39 weeks of gestation compared with expectant management in low-risk nulliparous women. The entire trial enrolled more than 6,000 patients. For this subset, 1,201 had cost data available. The primary outcome was relative direct health care costs of maternal and neonatal care from a health system perspective. Secondary outcomes included the costs of each phase of maternal and neonatal care. Direct health system costs of maternal and neonatal care were measured using advanced costing analytics from the time of randomization at 38 weeks of gestation until exit from the study up to 8 weeks postpartum. Costs in each randomization arm were compared using generalized linear models and reported as the relative cost of induction compared with expectant management. With a fixed sample size, we had adequate power to detect a 7.3% or greater difference in overall costs.
resultsThe total cost of elective induction was no different than expectant management (mean difference +4.7%; 95% CI -2.1% to +12.0%; P=.18). Maternal outpatient antenatal care costs were 47.0% lower in the induction arm (95% CI -58.3% to -32.6%; P<.001). Maternal inpatient intrapartum and delivery care costs, conversely, were 16.9% higher among women undergoing labor induction (95% CI +5.5% to +29.5%; P=.003). Maternal inpatient postpartum care, maternal outpatient care after discharge, neonatal hospital care, and neonatal care after discharge did not differ between arms.
conclusionTotal costs of elective labor induction and expectant management did not differ significantly. These results challenge the assumption that elective induction of labor leads to significant cost escalation.
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