P Blanc-Petitjean1, M Salomé2, C Dupont3, C Crenn-Hebert4, A Gaudineau5, F Perrotte6, P Raynal7, E Clouqueur8, G Beucher9, B Carbonne10, F Goffinet11, C Le Ray11. 1. Inserm UMR 1153, obstetrical, perinatal and pediatric epidemiology research team (EPOPé), centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), DHU risks in pregnancy, Paris Descartes university, 75014 Paris, France; Assistance Publique-Hôpitaux de Paris, Louis-Mourier hospital, Department of obstetrics and gynecology, Louis-Mourier hospital, hôpitaux universitaires Paris Nord Val-de-Seine, AP-HP, DHU risks in pregnancy, Paris Diderot university, 92700 Colombes, France. Electronic address: pauline.blanc-petitjean@inserm.fr. 2. URC-CIC Paris Descartes Necker/Cochin, AP-HP, Cochin hospital, 75014 Paris, France. 3. Réseau périnatal Aurore, hôpital de la Croix-Rousse, université Lyon 1, 69004 Lyon, France. 4. Assistance Publique-Hôpitaux de Paris, Louis-Mourier hospital, Department of obstetrics and gynecology, Louis-Mourier hospital, hôpitaux universitaires Paris Nord Val-de-Seine, AP-HP, DHU risks in pregnancy, Paris Diderot university, 92700 Colombes, France. 5. Department of obstetrics and gynecology, Strasbourg teaching hospital, 67200 Strasbourg, France. 6. Réseau de santé périnatal Parisien, 75010 Paris, France. 7. Department of obstetrics and gynecology, André-Mignot hospital, centre hospitalier de Versailles, 78150 Le Chesnay, France. 8. Pôle Femme-Mère-Nouveau-né, clinique d'obstétrique, Jeanne-de-Flandre hospital, university of Lille Nord de France, 59000 Lille, France. 9. Department of obstetrics, gynecology and reproductive medicine, CHU de Caen, 14033 Caen, France. 10. Department of obstetrics and gynecology, Princess Grace hospital, 98012 Monaco. 11. Inserm UMR 1153, obstetrical, perinatal and pediatric epidemiology research team (EPOPé), centre for epidemiology and statistics Sorbonne Paris Cité (CRESS), DHU risks in pregnancy, Paris Descartes university, 75014 Paris, France; Assistance Publique-Hôpitaux de Paris, Cochin hospital, Port-Royal maternity unit, Cochin hospital, hôpitaux universitaires Paris Centre, AP-HP, DHU risks in pregnancy, Paris Descartes university, 75014 Paris, France.
Abstract
INTRODUCTION: In 2016, 22.0% of deliveries in France were induced. The current lack of high level of evidence data about the methods and indications for induction of labour has promoted heterogeneous and non-recommended practices. The extent of these different practices is not adequately known in France today, although they may influence perinatal outcomes. The objective of this study was to report current practices of induction of labour in France. MATERIAL AND METHODS: This study surveyed 94 maternity units in seven perinatal networks. A questionnaire was sent by email to either the department head or delivery room supervisor of these units to ask about their methods for induction and their attitudes in specific obstetric situations. RESULTS: The rate of induction varied between maternity units from 7.7% to 33% of deliveries. Most units used two (39.4%) or three or more (35.1%) agents for cervical ripening. In all, 87 (92.6%) units reported using dinoprostone as a vaginal slow-released insert, 59 units dinosprostone as a vaginal gel (62.8%) and 46 units a balloon catheter (48.9%). Only three units reported using vaginal misoprostol. Inductions without medical indication were reported by 71 (75.5%) maternity units, and 22 (23.4%) units even when the cervix was unfavourable. Obstetric attitudes in cases of breech presentation, previous caesareans, fetal growth restriction or macrosomia and prelabour rupture of the membranes varied widely. DISCUSSION: The variability of practices for induction of labour and the persistence of disapproved practices call for an assessment of the effectiveness and the safety of the different strategies.
INTRODUCTION: In 2016, 22.0% of deliveries in France were induced. The current lack of high level of evidence data about the methods and indications for induction of labour has promoted heterogeneous and non-recommended practices. The extent of these different practices is not adequately known in France today, although they may influence perinatal outcomes. The objective of this study was to report current practices of induction of labour in France. MATERIAL AND METHODS: This study surveyed 94 maternity units in seven perinatal networks. A questionnaire was sent by email to either the department head or delivery room supervisor of these units to ask about their methods for induction and their attitudes in specific obstetric situations. RESULTS: The rate of induction varied between maternity units from 7.7% to 33% of deliveries. Most units used two (39.4%) or three or more (35.1%) agents for cervical ripening. In all, 87 (92.6%) units reported using dinoprostone as a vaginal slow-released insert, 59 units dinosprostone as a vaginal gel (62.8%) and 46 units a balloon catheter (48.9%). Only three units reported using vaginal misoprostol. Inductions without medical indication were reported by 71 (75.5%) maternity units, and 22 (23.4%) units even when the cervix was unfavourable. Obstetric attitudes in cases of breech presentation, previous caesareans, fetal growth restriction or macrosomia and prelabour rupture of the membranes varied widely. DISCUSSION: The variability of practices for induction of labour and the persistence of disapproved practices call for an assessment of the effectiveness and the safety of the different strategies.