The Role of Elective Induction of Labor at 39 Weeks Gestation in Reducing the Rate of Cesarean Section in Nulliparous Pregnant Females: A Prospective Cohort Study

Background: The increasing global rate of cesarean sections (CS) has prompted exploration of strategies to reduce unnecessary surgeries. Elective induction of labor (IOL) at 39 weeks in nulliparous women has emerged as a potential approach, though its safety and efficacy compared to expectant management remain controversial. This study evaluates whether elective IOL at 39 weeks reduces CS rates and associated maternal and neonatal complications.Methods: A prospective cohort study was conducted at Suez Canal University Hospital from January 2024 to January 2025. Sixty-eight nulliparous pregnant women at ≥39 weeks' gestation were divided into two groups based on modified Bishop scores: an induction group (n=34, Bishop score >6), undergoing elective induction with vaginal misoprostol (50 µg), and an expectant group (n=34, Bishop score ≤6), managed expectantly until spontaneous labor or 42 weeks gestation.Results: The induction group had a significantly higher vaginal delivery rate (91.2% vs. 70.6%, p=0.031) and a lower cesarean delivery rate (8.8% vs. 29.4%, p=0.031). No significant differences in fetal distress, neonatal intensive care unit (NICU) admissions, or Apgar scores were observed. Maternal side effects such as fever were slightly higher in the induction group but not statistically significant (23.5% vs. 11.8%, p=0.340). No cases of uterine hyperstimulation or significant maternal morbidity were reported.Conclusion: Elective induction at 39 weeks in nulliparous women significantly reduces the cesarean section rate without increasing adverse maternal or neonatal outcomes. Careful selection and monitoring enhance the safety and effectiveness of this approach.