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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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
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.
