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.

Autor: Bernardes, TP, Broekhuijsen, K, Koopmans, CM, Boers, KE, Wyk, L, Tajik, P, Pampus, MG, Scherjon, SA, Mol, BW, Franssen, MT, Berg, PP, Groen, H, Bernardes, T P, Koopmans, C M, Boers, K E, van Wyk, L, van Pampus, M G, Scherjon, S A, Mol, B W, Franssen, M T
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Zdroj: BJOG: An International Journal of Obstetrics & Gynaecology; Aug2016, Vol. 123 Issue 9, p1501-1508, 8p
Abstrakt: 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 Outcome Measures: 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. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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