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Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study

INTRODUCTION: This study aimed to assess whether induction of labor at 41 weeks of gestation improved perinatal outcomes in a low‐risk pregnancy compared with expectant management. MATERIAL AND METHODS: Registry‐based national cohort study in The Netherlands. The study population comprised 239 971 l...

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Autores principales: Ravelli, Anita C. J., van der Post, Joris A. M., de Groot, Christianne J. M., Abu‐Hanna, Ameen, Eskes, Martine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072249/
https://www.ncbi.nlm.nih.gov/pubmed/36915238
http://dx.doi.org/10.1111/aogs.14536
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author Ravelli, Anita C. J.
van der Post, Joris A. M.
de Groot, Christianne J. M.
Abu‐Hanna, Ameen
Eskes, Martine
author_facet Ravelli, Anita C. J.
van der Post, Joris A. M.
de Groot, Christianne J. M.
Abu‐Hanna, Ameen
Eskes, Martine
author_sort Ravelli, Anita C. J.
collection PubMed
description INTRODUCTION: This study aimed to assess whether induction of labor at 41 weeks of gestation improved perinatal outcomes in a low‐risk pregnancy compared with expectant management. MATERIAL AND METHODS: Registry‐based national cohort study in The Netherlands. The study population comprised 239 971 low‐risk singleton pregnancies from 2010 to 2019, with birth occurring from 41+0 to 42+0 weeks. We used propensity score matching to compare induction of labor in three 2‐day groups to expectant management, and further conducted separate analyses by parity. The main outcome measures were stillbirth, perinatal mortality, 5‐min Apgar <4 and <7, neonatal intensive care unit (NICU) admissions ≥24 h, and emergency cesarean section rate. RESULTS: Compared with expectant management, induction of labor at 41+0 to 41+1 weeks resulted in reduced stillbirths (adjusted odds ratio [aOR] 0.15, 95% confidence interval [CI] 0.05–0.51) in both nulliparous and multiparous women. Induction of labor increased 5‐min Apgar score <7 (aOR 1.30, 95% CI 1.09–1.55) and NICU admissions ≥24 h (aOR 2.12, 95% CI 1.53–2.92), particularly in nulliparous women, and increased the cesarean section rate (aOR 1.42, 95% CI 1.34–1.51). At 41+2–41+3 weeks, induction of labor reduced perinatal mortality (aOR 0.13, 95% CI 0.04–0.43) in both nulliparous and multiparous women. The rate of 5‐min Apgar score <7 was increased (aOR 1.26, 95% CI 1.06–1.50), reaching significance in multiparous women. The cesarean section rate increased (aOR 1.57, 95% CI 1.48–1.67) in both nulliparous and multiparous women. Induction of labor at 41+4 to 41+5 weeks reduced stillbirths (aOR 0.30, 95% CI 0.10–0.93). Induction of labor increased rates of 5‐min Apgar score <4 (aOR 1.61, 95% CI 1.01–2.56) and NICU admissions ≥24 h (aOR 1.52, 95% CI 1.08–2.13) in nulliparous women. Cesarean section rate was increased (aOR 1.47, 95% CI 1.38–1.57) in nulliparous and multiparous women. CONCLUSIONS: At 41+2 to 41+3 weeks, induction of labor reduced perinatal mortality, and in all 2‐day groups at 41 weeks, it reduced stillbirths, compared with expectant management. Low 5‐min Apgar score (<7 and <4) and NICU admissions ≥24 h occurred more often with induction of labor, especially in nulliparous women. Induction of labor in all 2‐day groups coincided with elevated cesarean section rates in nulliparous and multiparous women. These findings pertaining to the choice of induction of labor vs expectant management should be discussed when counseling women at 41 weeks of gestation.
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spelling pubmed-100722492023-04-05 Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study Ravelli, Anita C. J. van der Post, Joris A. M. de Groot, Christianne J. M. Abu‐Hanna, Ameen Eskes, Martine Acta Obstet Gynecol Scand Original Research Articles INTRODUCTION: This study aimed to assess whether induction of labor at 41 weeks of gestation improved perinatal outcomes in a low‐risk pregnancy compared with expectant management. MATERIAL AND METHODS: Registry‐based national cohort study in The Netherlands. The study population comprised 239 971 low‐risk singleton pregnancies from 2010 to 2019, with birth occurring from 41+0 to 42+0 weeks. We used propensity score matching to compare induction of labor in three 2‐day groups to expectant management, and further conducted separate analyses by parity. The main outcome measures were stillbirth, perinatal mortality, 5‐min Apgar <4 and <7, neonatal intensive care unit (NICU) admissions ≥24 h, and emergency cesarean section rate. RESULTS: Compared with expectant management, induction of labor at 41+0 to 41+1 weeks resulted in reduced stillbirths (adjusted odds ratio [aOR] 0.15, 95% confidence interval [CI] 0.05–0.51) in both nulliparous and multiparous women. Induction of labor increased 5‐min Apgar score <7 (aOR 1.30, 95% CI 1.09–1.55) and NICU admissions ≥24 h (aOR 2.12, 95% CI 1.53–2.92), particularly in nulliparous women, and increased the cesarean section rate (aOR 1.42, 95% CI 1.34–1.51). At 41+2–41+3 weeks, induction of labor reduced perinatal mortality (aOR 0.13, 95% CI 0.04–0.43) in both nulliparous and multiparous women. The rate of 5‐min Apgar score <7 was increased (aOR 1.26, 95% CI 1.06–1.50), reaching significance in multiparous women. The cesarean section rate increased (aOR 1.57, 95% CI 1.48–1.67) in both nulliparous and multiparous women. Induction of labor at 41+4 to 41+5 weeks reduced stillbirths (aOR 0.30, 95% CI 0.10–0.93). Induction of labor increased rates of 5‐min Apgar score <4 (aOR 1.61, 95% CI 1.01–2.56) and NICU admissions ≥24 h (aOR 1.52, 95% CI 1.08–2.13) in nulliparous women. Cesarean section rate was increased (aOR 1.47, 95% CI 1.38–1.57) in nulliparous and multiparous women. CONCLUSIONS: At 41+2 to 41+3 weeks, induction of labor reduced perinatal mortality, and in all 2‐day groups at 41 weeks, it reduced stillbirths, compared with expectant management. Low 5‐min Apgar score (<7 and <4) and NICU admissions ≥24 h occurred more often with induction of labor, especially in nulliparous women. Induction of labor in all 2‐day groups coincided with elevated cesarean section rates in nulliparous and multiparous women. These findings pertaining to the choice of induction of labor vs expectant management should be discussed when counseling women at 41 weeks of gestation. John Wiley and Sons Inc. 2023-03-13 /pmc/articles/PMC10072249/ /pubmed/36915238 http://dx.doi.org/10.1111/aogs.14536 Text en © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research Articles
Ravelli, Anita C. J.
van der Post, Joris A. M.
de Groot, Christianne J. M.
Abu‐Hanna, Ameen
Eskes, Martine
Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
title Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
title_full Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
title_fullStr Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
title_full_unstemmed Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
title_short Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
title_sort does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? a nationwide propensity score‐matched study
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072249/
https://www.ncbi.nlm.nih.gov/pubmed/36915238
http://dx.doi.org/10.1111/aogs.14536
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