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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

      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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