Objective: To evaluate whether elective induction of labour (eIOL) influences the rate of caesarean birth in uncomplicated pregnant women at term, compared to expectant management. Design: Retrospective cohort study. Setting: Births in Victoria between 2010 and 2018. Population: Term, singleton, vertex births from low-moderate risk pregnancies (n=396,164). Methods: Preliminary analyses compared eIOL at 37 weeks with expectant management both beyond that gestational age (preliminary analysis I) and at that gestational age and beyond (preliminary analysis II). Similar comparisons were made for eIOL at 38, 39, 40 and 41 weeks’ gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women whose recorded indication for induction did not include one of a specified list of conditions. Chi-square tests and multivariable logistic regression were used. Adjusted odds ratios and 99% confidence intervals were reported. P<0.01 denoted statistical significance. Main Outcome Measures: Unplanned caesarean birth, perinatal mortality Results: The proportion of nulliparous, low-moderate risk women who underwent IOL ≥37 weeks’ gestation in Victoria increased from 24.6% in 2010 to 30.0% in 2018 (p-value <0.001). eIOL in nulliparous women was associated with an increased odds of caesarean birth when performed at 38 (aOR 1.23((1.13-1.32)), 39 (aOR 1.31((1.23-1.40)), 40 (aOR 1.42((1.35-1.50)), and 41 weeks’ gestation (aOR 1.43((1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. Conclusions: eIOL was associated with an increased odds of caesarean birth from 38 weeks’ gestation and a decrease in the odds of perinatal mortality.

Objectives: In July 2017, Victoria’s largest maternity service implemented a new clinical guideline aimed to reduce the rates of stillbirth at term for South Asian-born women. Here we present the evaluation of the change in care on rates of stillbirth, neonatal and obstetric interventions. Design: Cohort Study Setting: Victoria’s largest metropolitan university-affiliated teaching hospital. Population: All women receiving antenatal care who gave birth in the term period between January 2016 and December 2020. Methods: Differences in rates of stillbirths, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of induction of labour. Main Outcome Measures: Rates of stillbirths, neonatal deaths, perinatal morbidities, and obstetric interventions. Results: 3506 south Asian-born women gave birth prior to, and 8532 after the change. There was a 64% reduction in term stillbirth (95%CI 87% to 2%; p=0.047) for south Asian-born women after the change in practice from 2.3 per 1000 births to 0.8 per 1000 births. The rates of early neonatal death (3.1 per 1000 vs 1.3 per 1000; p=0.03) and SCN admission (16.5% vs 11.1%; p<0.001) also decreased. There were no significant differences in admission to NICU, Apgar<7 at 5 minutes, birthweight or differences in the trends of induction of labour per month. Conclusions: Fetal monitoring from 39 weeks’ may offer an alternative to routine earlier induction of labour to reduce the rates of stillbirth without causing an increase in neonatal morbidity or obstetric interventions.