Decision Aid to Assist Low-Risk Nulliparous Women Considering Induction of Labor At 39 Weeks

Decision Aid to Assist Low-Risk Nulliparous Women Considering Induction of Labor At 39 Weeks: A Randomized Trial (DAWN Trial)

The primary objective is to assess if the utilization of a decision-aid increases the likelihood of low-risk nulliparous women undergoing elective induction of labor at 39.0-39.6 weeks

Inclusion Criteria:

• Low-risk nulliparous women- no previous pregnancy > 23 weeks
• 18-50 years of age
• Singleton gestation
• Between 34.0 and 36.6 weeks at the time of screening. Randomization must occur between 37.0-37.6 weeks inclusive.

Exclusion Criteria:

• 1. First sonographic examination after 20 weeks 2. Women with any of the following comorbidities (at the time of randomization):

  1. Autoimmune disorders (antiphospholipid antibody, lupus, rheumatoid arthritis, scleroderma)
  2. Cerclage in the index pregnancy
  3. Diabetes mellitus-gestational or pre-gestational
  4. Hematologic disorders (coagulation defects, sickle cell disease, thrombocytopenia, thrombophilia)
  5. Hypertension (chronic or pregnancy induced) before enrollment
  6. HIV (human immunodeficiency virus)
  7. Institutionalized individuals (prisoners)
  8. Prior obstetric history of: 1) intrauterine growth restriction, 2) preterm birth before 34 weeks, 3) severe preeclampsia, eclampsia, HELLP syndrome, and 4) stillbirth after 24 weeks or neonatal death
  9. Preterm labor or ruptured membranes before enrollment
  10. Psychiatric disorder (bipolar, depression) on medication
  11. Placenta previa / 3rd trimester bleeding
  12. Renal insufficiency (serum creatinine > 1.5 mg/dL)
  13. Restrictive lung disease
  14. Fetal red blood cell isoimmunization
  15. Seizure disorder on medication
  16. Thyroid disease on medication
  17. Body Mass Index (BMI) above 40 kg/m 3. Major fetal Anomaly including: anencephaly, spina bifida, bilateral renal agenesis, cystic hygroma with hydrops, diaphragmatic hernia, or congenital heart defects 4. Unable to understand consent in English or Spanish