T P Bernardes1, K Broekhuijsen2, C M Koopmans2, K E Boers3, L van Wyk4, P Tajik5, M G van Pampus6, S A Scherjon2, B W Mol7, M T Franssen2, P P van den Berg2, H Groen1. 1. Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands. 2. Department of Obstetrics & Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands. 3. Department of Obstetrics & Gynaecology, Bronovo Hospital, Den Haag, the Netherlands. 4. Department of Obstetrics & Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands. 5. Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, the Netherlands. 6. Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. 7. The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, SA, Australia.
Abstract
OBJECTIVE: To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. DESIGN: Secondary analysis of data from two randomised clinical trials. SETTING: Data were collected in two nationwide Dutch trials. POPULATION: Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6. METHODS: Comparison of outcomes after induction of labour and expectant management. MAIN OUTCOME MEASURES: Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH <7.05 and/or neonatal intensive care unit admission and/or seizures and/or perinatal death. RESULTS: Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference -1.1%, 95% CI -5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference -2.7%, 95% CI -7.6 to 2.2) or adverse neonatal outcome rates (difference -1.5%, 95% CI -4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference -3.2%, 95% CI -5.6 to -0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32. CONCLUSIONS: We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted. TWEETABLE ABSTRACT: Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome.
OBJECTIVE: To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. DESIGN: Secondary analysis of data from two randomised clinical trials. SETTING: Data were collected in two nationwide Dutch trials. POPULATION: Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6. METHODS: Comparison of outcomes after induction of labour and expectant management. MAIN OUTCOME MEASURES: Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH <7.05 and/or neonatal intensive care unit admission and/or seizures and/or perinatal death. RESULTS: Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference -1.1%, 95% CI -5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference -2.7%, 95% CI -7.6 to 2.2) or adverse neonatal outcome rates (difference -1.5%, 95% CI -4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference -3.2%, 95% CI -5.6 to -0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32. CONCLUSIONS: We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted. TWEETABLE ABSTRACT: Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome.
Authors: T P Bernardes; E F Zwertbroek; K Broekhuijsen; C Koopmans; K Boers; M Owens; J Thornton; M G van Pampus; S A Scherjon; K Wallace; J Langenveld; P P van den Berg; M T M Franssen; B W J Mol; H Groen Journal: Ultrasound Obstet Gynecol Date: 2019-04 Impact factor: 7.299
Authors: Leslie Skeith; Grégoire Le Gal; Johanna I P de Vries; Saskia Middeldorp; Mariëtte Goddijn; Risto Kaaja; Jean-Christophe Gris; Ida Martinelli; Ekkehard Schleußner; David Petroff; Nicole Langlois; Marc A Rodger Journal: BMC Pregnancy Childbirth Date: 2019-11-29 Impact factor: 3.007