Immediate induction versus expectant management in primiparas presenting with decreased fetal movements at 39 weeks

Objective: To evaluate maternal and neonatal outcomes in primiparous patients presenting with decreased fetal movements (DFM), comparing immediate induction of labor with expectant management. 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, and a normal biophysical profile. Patients were offered labor induction. Those who agreed formed the induction group, while those who declined and were discharged home comprised the control group. Maternal and neonatal outcomes were compared. Results: A total of 413 patients were included: 282 in the induction group and 131 in the expectant management group. Gestational age at delivery was lower in the induction group (39.4 ± 0.3 vs. 40.1 ± 0.3 weeks, p < 0.001). No significant differences were observed in birthweight, cesarean delivery rates, or neonatal intensive care unit (NICU) admission. The induction group had significantly fewer neonates with cord pH < 7.15 (2.5% vs. 6.9%, p = 0.034), and a shorter duration of neonatal hospitalization (2.0 ± 0.2 vs. 2.3 ± 0.5 days, p = 0.034); however, 5-min Apgar scores were similar between the groups. 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 slightly 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, labor induction was associated with earlier delivery and improved umbilical cord pH without increasing maternal or neonatal complications.