J K J Keulen1, P T Nieuwkerk2, J C Kortekaas3, J van Dillen3, B W Mol4, J A M van der Post5, E de Miranda5. 1. Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands. Electronic address: j.keulen@amsterdamumc.nl. 2. Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, The Netherlands. 3. Department of Obstetrics and Gynaecology, Radboud UMC, Nijmegen, The Netherlands. 4. Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. 5. Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, The Netherlands.
Abstract
BACKGROUND: Both induction of labour at 41 weeks and expectant management until 42 weeks are common management strategies in low-risk pregnancy since there is no consensus on the optimal timing of induction in late-term pregnancy for the prevention of adverse outcomes. Our aim was to explore maternal preference for either strategy and the influence on quality of life and maternal anxiety on this preference. METHODS: Obstetrical low-risk women with an uncomplicated pregnancy were eligible when they reached a gestational age of 41 weeks. They were asked to fill in questionnaires on quality of life (EQ6D) and anxiety (STAI-state). Reasons of women's preferences for either induction or expectant management were explored in a semi-structured questionnaire containing open ended questions. RESULTS: Of 782 invited women 604 (77.2%) responded. Induction at 41 weeks was preferred by 44.7% (270/604) women, 42.1% (254/604) preferred expectant management until 42 weeks, while 12.2% (74/604) of women did not have a preference. Women preferring induction reported significantly more problems regarding quality of life and were more anxious than women preferring expectant management (p<0.001). Main reasons for preferring induction of labour were: "safe feeling" (41.2%), "pregnancy taking too long" (35.4%) and "knowing what to expect" (18.6%). For women preferring expectant management, the main reason was "wish to give birth as natural as possible" (80.3%). CONCLUSION: Women's preference for induction of labour or a policy of expectant management in late-term pregnancy is influenced by anxiety, quality of life problems (induction), the presence of a wish for natural birth (expectant management), and a variety of additional reasons. This variation in preferences and motivations suggests that there is room for shared decision making in the management of late-term pregnancy.
BACKGROUND: Both induction of labour at 41 weeks and expectant management until 42 weeks are common management strategies in low-risk pregnancy since there is no consensus on the optimal timing of induction in late-term pregnancy for the prevention of adverse outcomes. Our aim was to explore maternal preference for either strategy and the influence on quality of life and maternal anxiety on this preference. METHODS: Obstetrical low-risk women with an uncomplicated pregnancy were eligible when they reached a gestational age of 41 weeks. They were asked to fill in questionnaires on quality of life (EQ6D) and anxiety (STAI-state). Reasons of women's preferences for either induction or expectant management were explored in a semi-structured questionnaire containing open ended questions. RESULTS: Of 782 invited women 604 (77.2%) responded. Induction at 41 weeks was preferred by 44.7% (270/604) women, 42.1% (254/604) preferred expectant management until 42 weeks, while 12.2% (74/604) of women did not have a preference. Women preferring induction reported significantly more problems regarding quality of life and were more anxious than women preferring expectant management (p<0.001). Main reasons for preferring induction of labour were: "safe feeling" (41.2%), "pregnancy taking too long" (35.4%) and "knowing what to expect" (18.6%). For women preferring expectant management, the main reason was "wish to give birth as natural as possible" (80.3%). CONCLUSION:Women's preference for induction of labour or a policy of expectant management in late-term pregnancy is influenced by anxiety, quality of life problems (induction), the presence of a wish for natural birth (expectant management), and a variety of additional reasons. This variation in preferences and motivations suggests that there is room for shared decision making in the management of late-term pregnancy.
Authors: Aafke Bruinsma; Judit Kj Keulen; Joep C Kortekaas; Jeroen van Dillen; Ruben G Duijnhoven; Patrick Mm Bossuyt; Anton H van Kaam; Joris Am van der Post; Ben W Mol; Esteriek de Miranda Journal: Eur J Obstet Gynecol Reprod Biol X Date: 2022-10-03
Authors: Helena Nilvér; Anna Wessberg; Anna Dencker; Henrik Hagberg; Ulla-Britt Wennerholm; Helena Fadl; Jan Wesström; Verena Sengpiel; Ingela Lundgren; Christina Bergh; Anna-Karin Wikström; Sissel Saltvedt; Helen Elden Journal: BMJ Open Date: 2021-04-07 Impact factor: 2.692