Effects of induction of labour versus expectant management in women with impending post-term pregnancies: the 41 week – 42 week dilemma

نویسندگان

  • Joep C Kortekaas
  • Aafke Bruinsma
  • Judit KJ Keulen
  • Jeroen van Dillen
  • Martijn A Oudijk
  • Joost J Zwart
  • Jannet JH Bakker
  • Dokie de Bont
  • Marianne Nieuwenhuijze
  • Pien M Offerhaus
  • Anton H van Kaam
  • Frank Vandenbussche
  • Ben Willem J Mol
  • Esteriek de Miranda
چکیده

BACKGROUND Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. METHODS/DESIGN In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. DISCUSSION This study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks. TRIAL REGISTRATION Dutch Trial Register (Nederlands Trial Register): NTR3431. Registered: 14 May 2012.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes.

BACKGROUND Recent literature on the effect of induction of labour (compared with expectant management) has provided conflicting results. Reviews of observational studies generally report an increase in the rate of caesarean section, whereas reviews of post-dates and term prelabour rupture of membrane (PROM trials suggest either no difference or a reduction in risk. OBJECTIVE To evaluate with ...

متن کامل

Outcomes of elective induction of labour compared with expectant management: population based study

OBJECTIVE To determine neonatal outcomes (perinatal mortality and special care unit admission) and maternal outcomes (mode of delivery, delivery complications) of elective induction of labour compared with expectant management. DESIGN Retrospective cohort study using an unselected population database. SETTING Consultant and midwife led obstetric units in Scotland 1981-2007. PARTICIPANTS 1...

متن کامل

Should pregnancies be induced for impending macrosomia?

www.thelancet.com Published online April 9, 2015 http://dx.doi.org/10.1016/S0140-6736(14)62302-3 1 Fetal macrosomia (usually defi ned as an estimated fetal weight or birthweight >4000 g or ≥4500 g) is associated with various perinatal complications. Irrespective of which weight threshold is used, macrosomic fetuses have higher rates of shoulder dystocia and subsequent birth trauma than do non-m...

متن کامل

Outcomes of elective induction of labour compared with expectant management: population based study OPEN ACCESS

Objective To determine neonatal outcomes (perinatal mortality and special care unit admission) and maternal outcomes (mode of delivery, delivery complications) of elective induction of labour compared with expectant management. Design Retrospective cohort study using an unselected population database. SettingConsultant andmidwife led obstetric units in Scotland 1981-2007. Participants 1 271 549...

متن کامل

Efficacy of castor oil for induction and augmentation of labor

Castor oil was first noted to have oxytocic properties by ancient Egyptians. Derived from the castor plant Ricinus communis, castor oil may possess properties that are useful are in post-term pregnancies This study was performed at Khatam-Alanbia, hospital in shoushtar city in 1381.In this clinical trail 80 pregnant women, who had indication for induction of labor at term were randomly assigned...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 14  شماره 

صفحات  -

تاریخ انتشار 2014