The effects of induction of labor prior to post-term in low-risk pregnancies: a systematic review

    Publikation: Konferencebidrag uden forlag/tidsskriftPosterForskningpeer review

    Abstract

    Rationale

    When a pregnancy is post-term, i.e. exceeding 14 days past estimated due date, it has long been obstetric practice to recommend induction of labor. In the context of a general trend towards earlier inductions, we wished to clarify whether this shift in clinical practice implies negative maternal or perinatal consequences. Hence, we examined effects of routine induction at 41+0-6 compared to 42+0-6 gestational weeks (GW) in low-risk pregnancies.

    Method

    We performed a systematic review and used validated tools for study selection and quality/evidence assessment (Joanna Briggs Institute; GRADE). We included 2 randomized and 2 quasi-experimental trials, and 3 cohort studies andcalculated relative risk ratios (RR), mean differences, and 95% confidence intervals (CI), on pooled data where relevant.

    Results/Conclusions

    Compared to expectant management, we found routine labor induction at 41+0-6 GW associated with the following outcomes (RR and CI in brackets): cesarean section (overall) (1.11 [1.09-1.14]), cesarean section (failure to progress) (1.43 [1.01-2.01]), chorioamnionitis (1.13 [1.05-1.21]), labor dystocia (1.29 [1.22-1.37]), precipitate labor (2.75 [1.45-5.20]), uterine rupture (1.97 [1.54-2.52]), pH < 7.10 (1.90 [1.48-2.43]), oligohydramnios (0.40 [0.24-0.67], and meconium stained amniotic fluid (0.82 [0.75-0.91]). Data did not allow for conclusions on perinatal death.

    Implications

    Our findings do not support routine labor induction prior to post-term (41+0-6 GW) in low-risk pregnancies, and desirable effects do not appear to outweigh undesirable effects. We recommend an increased awareness about inclusion criteria in systematic reviews when used for guideline development to ensure that the evidence base for clinical guidelines is based on studies that reflect contemporary practice.

    OriginalsprogEngelsk
    Publikationsdatosep. 2018
    StatusUdgivet - sep. 2018
    BegivenhedFrom Birth to Health: Towards sustainable childbirth - ISCTE-University Institute of Lisbon, Lissabon, Portugal
    Varighed: 17 sep. 201818 sep. 2018
    https://eubirthresearch.wixsite.com/eubirthconf18

    Konference

    KonferenceFrom Birth to Health
    LokationISCTE-University Institute of Lisbon
    Land/OmrådePortugal
    ByLissabon
    Periode17/09/1818/09/18
    Internetadresse

    Citationsformater