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Obstetrics • Obstétrique| Volume 44, ISSUE 11, P1159-1166, November 2022

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Elective Induction of Labour at 39 Weeks Compared With Expectant Management in Nulliparous Persons Delivering in a Community Hospital

Published:September 12, 2022DOI:https://doi.org/10.1016/j.jogc.2022.09.002
Elective Induction of Labour at 39 Weeks Compared With Expectant Management in Nulliparous Persons Delivering in a Community Hospital
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      Abstract

      Objective

      To determine the impact of offering elective labour induction at 39 weeks gestation on perinatal and maternal outcomes in nulliparous people with low-risk pregnancies.

      Methods

      The charts of all pregnant people who delivered at Brockville General Hospital between September 2018 and December 2021 were retrospectively reviewed. Perinatal and maternal outcomes of low-risk nulliparous pregnant people who underwent elective induction at 39 weeks and over were extracted and compared with those of low-risk nulliparous pregnant people who underwent expectant management. Exclusion criteria included multiparous people, high-risk pregnancies, multiple gestations, deliveries at less than 39 weeks gestation, and elective cesarean deliveries. Univariate and multivariate analysis was performed.

      Results

      A total of 174 patients were included. Of these patients, 56 (32.2%) underwent elective induction of labour between 390 and 396 weeks gestation over the period of June 2020 to December 2021, whereas 118 (67.8%) were expectantly managed from 390 weeks gestation over the period of September 2018 to March 2020. Compared with expectant management, those in the 39+ weeks induction group had a significantly lower risk of cesarean delivery (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.15–0.99), composite adverse maternal outcomes (OR 0.34; 95% CI 0.12–0.97), and composite adverse perinatal outcomes (OR 0.26; 95% CI 0.074–0.92).

      Conclusion

      Our results suggest that elective induction of labour at 39 weeks gestation and over in low-risk nulliparous people is associated with lower risks of cesarean delivery, composite adverse maternal outcomes, and composite adverse perinatal outcomes than expectant management.

      Résumé

      Objectif

      Déterminer l’incidence du déclenchement du travail planifié offert à 39 semaines d’aménorrhée (SA) sur les issues périnatales et maternelles chez les nullipares menant une grossesse à faible risque.

      Méthodologie

      Les dossiers de toutes les personnes qui ont accouché au Brockville General Hospital dans la période de septembre 2018 à décembre 2021 ont fait l’objet d’un examen rétrospectif. Chez les nullipares menant une grossesse à faible risque, les issues périnatales et maternelles suivant un déclenchement du travail planifié à 39 SA ou plus ont été extraites puis comparées aux issues suivant une prise en charge par expectative. Les critères d’exclusion étaient les suivants : multipare, grossesse à risque élevé, grossesse multiple, accouchement avant 39 SA et césarienne planifiée. Des analyses univariée et multivariée ont été effectuées.

      Résultats

      Un total de 174 patientes ont été incluses. De ces patientes, 56 (32,2 %) ont subi un déclenchement planifié du travail entre 39 SA + 0 j et 39 SA + 6 j dans la période de juin 2020 à décembre 2021, tandis que 118 (67,8 %) ont eu une prise en charge par expectative à partir de 39 SA+ 0 j pendant la période de septembre 2018 à mars 2020. Comparativement au groupe de la prise en charge par expectative, le groupe du déclenchement du travail à partir de 39 SA a présenté une diminution significative du risque de césarienne (rapport de cotes [RC] : 0,39; intervalle de confiance [IC] à 95 % : 0,15–0,99), d’issues maternelles défavorables composites (RC : 0,34; IC à 95 % : 0,12–0,97) et d’issues périnatales défavorables composites (RC : 0,26; IC à 95 % : 0,074–0,92).

      Conclusion

      Nos résultats indiquent que le déclenchement artificiel du travail planifié à 39 SA ou plus chez les nullipares à faible risque est associé à une diminution du risque de césarienne, d’issues maternelles défavorables composites et d’issues périnatales défavorables composites par comparaison à la prise en charge par expectative.

      Keywords

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      References

      1. Health Canada. Canadian perinatal health report, 2003. Ottawa: Government of Canada.
        (Available at:)
        http://publications.gc.ca/site/eng/252200/publication.html
        Date: 2003
        Date accessed: April 26, 2022
        View in Article
      2. Health Canada. Canadian perinatal health report, 2008. Ottawa: Government of Canada.
        (Available at:)
        http://www.phac-aspc.gc.ca/publicat/2008/cphr-rspc/pdf/ cphr-rspc08-eng
        Date: 2008
        Date accessed: April 26, 2022
        View in Article
      3. Health Canada. Family centred maternity and newborn care: national guidelines, 2018. Ottawa: Government of Canada.
        (Available at:)
        https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-4.html#a10
        Date: 2018
        Date accessed: April 26, 2022
        View in Article
        • Leduc D.
        • Biringer A.
        • Lee L.
        • et al.
        Induction of labour.
        J Obstet Gynaecol Can. 2013; 35: 840-857
        View in Article
        • Marconi A.M.
        Recent advances in the induction of labor.
        F1000Res. 2019; 8: F1000
        View in Article
        • Grobman W.A.
        • Rice M.M.
        • Reddy U.M.
        • et al.
        Labor induction versus expectant management in low-risk nulliparous women.
        New Engl J Med. 2018; 379: 513-523
        View in Article
        • Van den Hof M.C.
        • Smithies M.
        • Nevo O.
        • et al.
        No. 375-Clinical practice guideline on the use of first trimester ultrasound.
        J Obstet Gynaecol Can. 2019; 41: 388-395
        View in Article
        • Osmundson S.
        • Ou-Yang R.J.
        • Grobman W.A.
        Elective induction compared with expectant management in nulliparous women with an unfavorable cervix.
        Obstet Gynecol. 2011; 117: 583-587
        View in Article
        • Gibson K.S.
        • Waters T.P.
        • Bailit J.L.
        Maternal and neonatal outcomes in electively induced low-risk term pregnancies.
        Am J Obstet Gynecol. 2014; 211 (249.e1–16)
        View in Article
        • Stock S.J.
        • Ferguson E.
        • Duffy A.
        • et al.
        Outcomes of elective induction of labour compared with expectant management: population-based study.
        BMJ. 2012; 344: e2838
        View in Article
        • Cheng Y.W.
        • Kaimal A.J.
        • Snowden J.M.
        • et al.
        Induction of labor compared to expectant management in low-risk women and associated perinatal outcomes.
        Am J Obstet Gynecol. 2012; 207 (502.e1–8)
        View in Article
        • Darney B.G.
        • Snowden J.M.
        • Cheng Y.W.
        • et al.
        Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes.
        Obstet Gynecol. 2013; 122: 761-769
        View in Article
        • Caughey A.B.
        • Sundaram V.
        • Kaimal A.J.
        • et al.
        Maternal and neonatal outcomes of elective induction of labor.
        Evid Rep Technol Assess (Full Rep). 2009; 176: 1-257
        View in Article
        • Caughey A.B.
        • Sundaram V.
        • Kaimal A.J.
        • et al.
        Systematic review: elective induction of labor versus expectant management of pregnancy.
        Ann Intern Med. 2009; 151 (252–63, W53–63)
        View in Article
        • Kawakita T.
        • Iqbal S.N.
        • Huang C.C.
        • et al.
        Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery.
        Am J Obstet Gynecol. 2017; 217: 451.e1-451.e8
        View in Article
        • Gibson K.S.
        • Waters T.P.
        • Bailit J.L.
        A risk of waiting: the weekly incidence of hypertensive disorders and associated maternal and neonatal morbidity in low-risk term pregnancies.
        Am J Obstet Gynecol. 2016; 214 (389.e1–12)
        View in Article
        • Souter V.
        • Painter I.
        • Sitcov K.
        • et al.
        Maternal and newborn outcomes with elective induction of labor at term.
        Am J Obstet Gynecol. 2019; 220 (273.e1–11)
        View in Article
        • Walker K.F.
        • Bugg G.J.
        • Macpherson M.
        • et al.
        Randomized trial of labor induction in women 35 years of age or older.
        New Engl J Med. 2016; 374: 813-822
        View in Article
        • Keulen J.K.
        • Bruinsma A.
        • Kortekaas J.C.
        • et al.
        Induction of labour at 41 weeks versus expectant management until 42 weeks (INDEX): multicentre, randomised non-inferiority trial.
        BMJ. 2019; 364: I344
        View in Article
        • Vardo J.H.
        • Thornburg L.L.
        • Glantz J.C.
        Maternal and neonatal morbidity among nulliparous women undergoing elective induction of labor.
        J Reprod Med. 2011; 56: 25-30
        View in Article
        • Dunne C.
        • Da Silva O.
        • Schmidt G.
        • et al.
        Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks’ gestation.
        J Obstet Gynaecol Can. 2009; 31: 1124-1130
        View in Article
        • Guerra G.V.
        • Cecatti J.G.
        • Souza J.P.
        • et al.
        Elective induction versus spontaneous labour in Latin America.
        Bull World Health Organ. 2011; 89: 657-665
        View in Article
        • van Gemund N.
        • Hardeman A.
        • Scherjon S.A.
        • et al.
        Intervention rates after elective induction of labor compared to labor with a spontaneous onset. A matched cohort study.
        Gynecol Obstet Invest. 2003; 56: 133-138
        View in Article
        • Vrouenraets F.P.
        • Roumen F.J.
        • Dehing C.J.
        • et al.
        Bishop score and risk of cesarean delivery after induction of labor in nulliparous women.
        Obstet Gynecol. 2005; 105: 690-697
        View in Article
        • Vahratian A.
        • Zhang J.
        • Troendle J.F.
        Labor progression and risk of cesarean delivery in electively induced nulliparas.
        Obstet Gynecol. 2005; 105: 698-704
        View in Article
        • Seyb S.T.
        • Berka R.J.
        • Socol M.L.
        • et al.
        Risk of cesarean delivery with elective induction of labor at term in nulliparous women.
        Obstet Gynecol. 1999; 94: 600-607
        View in Article
        • Yeast J.D.
        • Jones A.
        • Poskin M.
        Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions.
        Am J Obstet Gynecol. 1999; 180: 628-633
        View in Article
        • Johnson D.P.
        • Davis R.N.
        • Brown A.J.
        Risk of cesarean delivery after induction at term in nulliparous women with an unfavorable cervix.
        Am J Obstet Gynecol. 2003; 188: 1565-1569
        View in Article
        • Chyu J.K.
        • Strassner H.T.
        Prostaglandin E2 for cervical ripening: a randomized comparison of Cervidil versus Prepidil.
        Am J Obstet Gynecol. 1997; 177: 606-611
        View in Article

      Article info

      Publication history

      Published online: September 12, 2022
      Accepted: September 1, 2022
      Received: July 17, 2022

      Footnotes

      Disclosures: The authors declare they have nothing to disclose.

      All authors have indicated they meet the journal’s requirements for authorship.

      Identification

      DOI: https://doi.org/10.1016/j.jogc.2022.09.002

      Copyright

      © 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

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