LAUSR

have increased dramatically. There is therefore no guarantee that recommending IOL at 39 weeks gestation for all nulliparous women would reduce the national cesarean delivery rate or indeed be acceptable to most pregnant women. That being said, there are consistentfindings across a variety of settings that term elective IOL, when compared with expectant management, leads to either a reduction or no difference in cesarean deliveries. Additionally, in a recent systematic review, the findings from previous cohort studies that examined this question essentially found a similar effect size to the randomized trials. Thus, although the impact on cesarean delivery in lower intervention settings may have a lower absolute impact, there is no evidence to suggest it may lead to harm. However, going forward, a better understanding of the economic, resource, and long-term implications of elective induction at term will be important areas for investigation. -