Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials.
BJOG
; 123(9): 1501-8, 2016 Aug.
Article
en En
| MEDLINE
| ID: mdl-27173131
ABSTRACT
OBJECTIVE:
To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term.DESIGN:
Secondary analysis of data from two randomised clinical trials.SETTING:
Data were collected in two nationwide Dutch trials. POPULATION Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6.METHODS:
Comparison of outcomes after induction of labour and expectant management. MAIN OUTCOMEMEASURES:
Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH <7.05 and/or neonatal intensive care unit admission and/or seizures and/or perinatal death.RESULTS:
Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference -1.1%, 95% CI -5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference -2.7%, 95% CI -7.6 to 2.2) or adverse neonatal outcome rates (difference -1.5%, 95% CI -4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference -3.2%, 95% CI -5.6 to -0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32.CONCLUSIONS:
We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted. TWEETABLE ABSTRACT Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Preeclampsia
/
Convulsiones
/
Unidades de Cuidado Intensivo Neonatal
/
Cesárea
/
Maduración Cervical
/
Retardo del Crecimiento Fetal
/
Espera Vigilante
/
Muerte Perinatal
/
Enfermedades del Recién Nacido
/
Trabajo de Parto Inducido
Tipo de estudio:
Clinical_trials
Límite:
Adult
/
Female
/
Humans
/
Infant
/
Newborn
/
Pregnancy
Idioma:
En
Revista:
BJOG
Asunto de la revista:
GINECOLOGIA
/
OBSTETRICIA
Año:
2016
Tipo del documento:
Article
País de afiliación:
Países Bajos