Aafke Bruinsma1,2, Judit Kj Keulen1,3, Joep C Kortekaas4, Jeroen van Dillen5, Ruben G Duijnhoven1, Patrick Mm Bossuyt6, Anton H van Kaam7, Joris Am van der Post1, Ben W Mol8,9, Esteriek de Miranda1. 1. Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands. 2. Rotterdam University of Applied Sciences, School of Midwifery, Rochussenstraat 198, Rotterdam, the Netherlands. 3. Zuyd University, Research Center for Midwifery Science, Faculty Midwifery Education & Studies Maastricht, Universiteitssingel 60, Maastricht, the Netherlands. 4. Elkerliek Medical Center, Department of Obstetrics & Gynaecology, Wesselmanlaan 25, Helmond, the Netherlands. 5. Radboud University Medical Center, Department of Obstetrics & Gynaecology, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands. 6. Amsterdam UMC, University of Amsterdam, Department of Epidemiology & Data Science, Meibergdreef 9, Amsterdam, the Netherlands. 7. Amsterdam UMC, University of Amsterdam, Emma, Children's hospital, Department of Neonatology, Meibergdreef 9, Amsterdam, the Netherlands. 8. Monash University, Department of Obstetrics and Gynaecology, 246 Clayton Road, Clayton, Victoria, Australia. 9. University of Aberdeen, Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, AB24 3FX Aberdeen, UK.
Abstract
Objective: To assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy. Design: Multicentre prospective cohort study alongside RCT. Setting: 90 midwifery practices and 12 hospitals in the Netherlands. Population: 3642 low-risk women with uncomplicated singleton late-term pregnancy. Main outcome measures: Composite adverse outcome (perinatal death, Apgar score 5' < 7, NICU admission, meconium aspiration syndrome), composite severe adverse perinatal outcome (all above with Apgar score 5' < 4 instead of < 7) and caesarean section. Results: From 2012-2016, 3642 women out of 6088 eligible women for the INDEX RCT, participated in the cohort study for observational data collection (induction of labour n = 372; expectant management n = 2174; unknown preference/management strategy n = 1096).Adverse perinatal outcome occurred in 1.1 % (4/372) in the induction group versus 1.9 % (42/2174) in the expectant group (adjRR 0.56; 95 %CI: 0.17-1.79), with severe adverse perinatal outcome occurring in 0.3 % (1/372) versus 1.0 % (22/2174), respectively (adjRR 0.39; 95 % CI: 0.05-2.88). There were no stillbirths among all 3642 women; one neonatal death occurred in the unknown preference/management group. Caesarean section rates were 10.5 % (39/372) after induction and 8.9 % (193/2174) after expectant management (adjRR 1.32; 95 % CI: 0.95-1.84).A higher incidence of adverse perinatal outcome was observed in nulliparous compared to multiparous women. Nulliparous 1.8 % (3/170) in the induction group versus 2.6 % (30/1134) in the expectant management group (adjRR 0.58; 95 % CI 0.14-2.41), multiparous 0.5 % (1/201) versus 1.1 % (11/1039) (adjRR 0.54; 95 % CI 0.07-24.19). One maternal death due to amniotic fluid embolism occurred after elective induction at 41 weeks + 6 days. Conclusion: In this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1 % versus 1.9 %) and severe adverse (0.3 % versus 1.0 %) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3642 women. Caesarean section rates were comparable.
Objective: To assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy. Design: Multicentre prospective cohort study alongside RCT. Setting: 90 midwifery practices and 12 hospitals in the Netherlands. Population: 3642 low-risk women with uncomplicated singleton late-term pregnancy. Main outcome measures: Composite adverse outcome (perinatal death, Apgar score 5' < 7, NICU admission, meconium aspiration syndrome), composite severe adverse perinatal outcome (all above with Apgar score 5' < 4 instead of < 7) and caesarean section. Results: From 2012-2016, 3642 women out of 6088 eligible women for the INDEX RCT, participated in the cohort study for observational data collection (induction of labour n = 372; expectant management n = 2174; unknown preference/management strategy n = 1096).Adverse perinatal outcome occurred in 1.1 % (4/372) in the induction group versus 1.9 % (42/2174) in the expectant group (adjRR 0.56; 95 %CI: 0.17-1.79), with severe adverse perinatal outcome occurring in 0.3 % (1/372) versus 1.0 % (22/2174), respectively (adjRR 0.39; 95 % CI: 0.05-2.88). There were no stillbirths among all 3642 women; one neonatal death occurred in the unknown preference/management group. Caesarean section rates were 10.5 % (39/372) after induction and 8.9 % (193/2174) after expectant management (adjRR 1.32; 95 % CI: 0.95-1.84).A higher incidence of adverse perinatal outcome was observed in nulliparous compared to multiparous women. Nulliparous 1.8 % (3/170) in the induction group versus 2.6 % (30/1134) in the expectant management group (adjRR 0.58; 95 % CI 0.14-2.41), multiparous 0.5 % (1/201) versus 1.1 % (11/1039) (adjRR 0.54; 95 % CI 0.07-24.19). One maternal death due to amniotic fluid embolism occurred after elective induction at 41 weeks + 6 days. Conclusion: In this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1 % versus 1.9 %) and severe adverse (0.3 % versus 1.0 %) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3642 women. Caesarean section rates were comparable.
Authors: Philip Blumenshine; Susan Egerter; Colleen J Barclay; Catherine Cubbin; Paula A Braveman Journal: Am J Prev Med Date: 2010-09 Impact factor: 5.043
Authors: O Gelisen; E Caliskan; S Dilbaz; E Ozdas; B Dilbaz; E Ozdas; A Haberal Journal: Eur J Obstet Gynecol Reprod Biol Date: 2005-06-01 Impact factor: 2.435
Authors: Joep C Kortekaas; Aafke Bruinsma; Judit K J Keulen; Frank P H A Vandenbussche; Jeroen van Dillen; Esteriek de Miranda Journal: BMC Pregnancy Childbirth Date: 2019-05-22 Impact factor: 3.007