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Outcomes of elective induction of labour compared with expectant management: population based study.
BMJ. 2012 May 10; 344:e2838.BMJ

Abstract

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

1,271,549 women with singleton pregnancies of 37 weeks or more gestation.

INTERVENTIONS

Outcomes of elective induction of labour (induction of labour with no recognised medical indication) at 37, 38, 39, 40, and 41 weeks' gestation compared with those of expectant management (continuation of pregnancy to either spontaneous labour, induction of labour or caesarean section at a later gestation).

MAIN OUTCOME MEASURES

Extended perinatal mortality, mode of delivery, postpartum haemorrhage, obstetric anal sphincter injury, and admission to a neonatal or special care baby unit. Outcomes were adjusted for age at delivery, parity, year of birth, birth weight, deprivation category, and, where appropriate, mode of delivery.

RESULTS

At each gestation between 37 and 41 completed weeks, elective induction of labour was associated with a decreased odds of perinatal mortality compared with expectant management (at 40 weeks' gestation 0.08% (37/44,764) in the induction of labour group versus 0.18% (627/350,643) in the expectant management group; adjusted odds ratio 0.39, 99% confidence interval 0.24 to 0.63), without a reduction in the odds of spontaneous vertex delivery (at 40 weeks' gestation 79.9% (35,775/44,778) in the induction of labour group versus 73.7% (258,665/350,791) in the expectant management group; adjusted odds ratio 1.26, 1.22 to 1.31). Admission to a neonatal unit was, however, increased in association with elective induction of labour at all gestations before 41 weeks (at 40 weeks' gestation 8.0% (3605/44,778) in the induction of labour group compared with 7.3% (25,572/350,791) in the expectant management group; adjusted odds ratio 1.14, 1.09 to 1.20).

CONCLUSION

Although residual confounding may remain, our findings indicate that elective induction of labour at term gestation can reduce perinatal mortality in developed countries without increasing the risk of operative delivery.

Authors+Show Affiliations

Tommy's Centre for Maternal and Fetal Health, MRC Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, UK. sarah.stock@ed.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22577197

Citation

Stock, Sarah J., et al. "Outcomes of Elective Induction of Labour Compared With Expectant Management: Population Based Study." BMJ (Clinical Research Ed.), vol. 344, 2012, pp. e2838.
Stock SJ, Ferguson E, Duffy A, et al. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ. 2012;344:e2838.
Stock, S. J., Ferguson, E., Duffy, A., Ford, I., Chalmers, J., & Norman, J. E. (2012). Outcomes of elective induction of labour compared with expectant management: population based study. BMJ (Clinical Research Ed.), 344, e2838. https://doi.org/10.1136/bmj.e2838
Stock SJ, et al. Outcomes of Elective Induction of Labour Compared With Expectant Management: Population Based Study. BMJ. 2012 May 10;344:e2838. PubMed PMID: 22577197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of elective induction of labour compared with expectant management: population based study. AU - Stock,Sarah J, AU - Ferguson,Evelyn, AU - Duffy,Andrew, AU - Ford,Ian, AU - Chalmers,James, AU - Norman,Jane E, Y1 - 2012/05/10/ PY - 2012/5/12/entrez PY - 2012/5/12/pubmed PY - 2012/7/4/medline SP - e2838 EP - e2838 JF - BMJ (Clinical research ed.) JO - BMJ VL - 344 N2 - 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: 1,271,549 women with singleton pregnancies of 37 weeks or more gestation. INTERVENTIONS: Outcomes of elective induction of labour (induction of labour with no recognised medical indication) at 37, 38, 39, 40, and 41 weeks' gestation compared with those of expectant management (continuation of pregnancy to either spontaneous labour, induction of labour or caesarean section at a later gestation). MAIN OUTCOME MEASURES: Extended perinatal mortality, mode of delivery, postpartum haemorrhage, obstetric anal sphincter injury, and admission to a neonatal or special care baby unit. Outcomes were adjusted for age at delivery, parity, year of birth, birth weight, deprivation category, and, where appropriate, mode of delivery. RESULTS: At each gestation between 37 and 41 completed weeks, elective induction of labour was associated with a decreased odds of perinatal mortality compared with expectant management (at 40 weeks' gestation 0.08% (37/44,764) in the induction of labour group versus 0.18% (627/350,643) in the expectant management group; adjusted odds ratio 0.39, 99% confidence interval 0.24 to 0.63), without a reduction in the odds of spontaneous vertex delivery (at 40 weeks' gestation 79.9% (35,775/44,778) in the induction of labour group versus 73.7% (258,665/350,791) in the expectant management group; adjusted odds ratio 1.26, 1.22 to 1.31). Admission to a neonatal unit was, however, increased in association with elective induction of labour at all gestations before 41 weeks (at 40 weeks' gestation 8.0% (3605/44,778) in the induction of labour group compared with 7.3% (25,572/350,791) in the expectant management group; adjusted odds ratio 1.14, 1.09 to 1.20). CONCLUSION: Although residual confounding may remain, our findings indicate that elective induction of labour at term gestation can reduce perinatal mortality in developed countries without increasing the risk of operative delivery. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/22577197/Outcomes_of_elective_induction_of_labour_compared_with_expectant_management:_population_based_study_ L2 - https://www.bmj.com/lookup/pmidlookup?view=long&pmid=22577197 DB - PRIME DP - Unbound Medicine ER -