Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study
Abstract 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 23...
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Wiley
2023-05-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14536 |
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| author | Anita C. J. Ravelli Joris A. M. van derPost Christianne J. M. deGroot Ameen Abu‐Hanna Martine Eskes |
| author_facet | Anita C. J. Ravelli Joris A. M. van derPost Christianne J. M. deGroot Ameen Abu‐Hanna Martine Eskes |
| author_sort | Anita C. J. Ravelli |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-b7ed9629ac5e4e5a90f8167e5de00de0 |
| institution | Kabale University |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2023-05-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-b7ed9629ac5e4e5a90f8167e5de00de02025-08-20T03:30:56ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122023-05-01102561262510.1111/aogs.14536Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched studyAnita C. J. Ravelli0Joris A. M. van derPost1Christianne J. M. deGroot2Ameen Abu‐Hanna3Martine Eskes4Department of Medical Informatics AmsterdamUMC Location University of Amsterdam Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology AmsterdamUMC Location University of Amsterdam Amsterdam The NetherlandsDepartment of Obstetrics and Gynecology AmsterdamUMC Location University of Amsterdam Amsterdam The NetherlandsDepartment of Medical Informatics AmsterdamUMC Location University of Amsterdam Amsterdam The NetherlandsDepartment of Medical Informatics AmsterdamUMC Location University of Amsterdam Amsterdam The NetherlandsAbstract 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.https://doi.org/10.1111/aogs.14536adverse neonatal outcomeemergency cesarean sectioninduction of laborprolonged pregnancypropensity score matching |
| spellingShingle | Anita C. J. Ravelli Joris A. M. van derPost Christianne J. M. deGroot Ameen Abu‐Hanna Martine Eskes Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study Acta Obstetricia et Gynecologica Scandinavica adverse neonatal outcome emergency cesarean section induction of labor prolonged pregnancy propensity score matching |
| 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 | adverse neonatal outcome emergency cesarean section induction of labor prolonged pregnancy propensity score matching |
| url | https://doi.org/10.1111/aogs.14536 |
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