OBJECTIVE: To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs). DESIGN AND SETTING: Nationwide retrospective register study between 2000 and 2007. POPULATION: All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198). METHODS: All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. MAIN OUTCOME MEASURES: Perinatal morbidity. RESULTS: In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered. CONCLUSION: A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.
OBJECTIVE: To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs). DESIGN AND SETTING: Nationwide retrospective register study between 2000 and 2007. POPULATION: All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198). METHODS: All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. MAIN OUTCOME MEASURES: Perinatal morbidity. RESULTS: In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered. CONCLUSION: A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.
Authors: Ulla-Britt Wennerholm; Sissel Saltvedt; Anna Wessberg; Mårten Alkmark; Christina Bergh; Sophia Brismar Wendel; Helena Fadl; Maria Jonsson; Lars Ladfors; Verena Sengpiel; Jan Wesström; Göran Wennergren; Anna-Karin Wikström; Helen Elden; Olof Stephansson; Henrik Hagberg Journal: BMJ Date: 2019-11-20
Authors: Mårten Alkmark; Judit K J Keulen; Joep C Kortekaas; Christina Bergh; Jeroen van Dillen; Ruben G Duijnhoven; Henrik Hagberg; Ben Willem Mol; Mattias Molin; Joris A M van der Post; Sissel Saltvedt; Anna-Karin Wikström; Ulla-Britt Wennerholm; Esteriek de Miranda Journal: PLoS Med Date: 2020-12-08 Impact factor: 11.069
Authors: Helen Elden; Henrik Hagberg; Anna Wessberg; Verena Sengpiel; Andreas Herbst; Maria Bullarbo; Christina Bergh; Kristian Bolin; Snezana Malbasic; Sissel Saltvedt; Olof Stephansson; Anna-Karin Wikström; Lars Ladfors; Ulla-Britt Wennerholm Journal: BMC Pregnancy Childbirth Date: 2016-03-07 Impact factor: 3.007