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Kortekaas JC, Bruinsma A, Keulen JKJ, Vandenbussche FP, van Dillen J, de Miranda E. Management of late-term pregnancy in midwifery- and obstetrician-led care. BMC Pregnancy Childbirth 2019; 19:181. [PMID: 31117985 PMCID: PMC6532173 DOI: 10.1186/s12884-019-2294-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/12/2019] [Indexed: 11/24/2022] Open
Abstract
Management of late-term pregnancy in midwifery- and obstetrician-led care. BACKGROUND Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy. METHODS Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions. RESULTS The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001). CONCLUSIONS Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.
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Affiliation(s)
- Joep C. Kortekaas
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Aafke Bruinsma
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Judit K. J. Keulen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Frank P.H.A. Vandenbussche
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6523 GA Nijmegen, the Netherlands
| | - Esteriek de Miranda
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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Kortekaas JC, Bruinsma A, Keulen JKJ, van Dillen J, Oudijk MA, Zwart JJ, Bakker JJH, de Bont D, Nieuwenhuijze M, Offerhaus PM, van Kaam AH, Vandenbussche F, Mol BWJ, de Miranda E. Effects of induction of labour versus expectant management in women with impending post-term pregnancies: the 41 week - 42 week dilemma. BMC Pregnancy Childbirth 2014; 14:350. [PMID: 25338555 PMCID: PMC4288619 DOI: 10.1186/1471-2393-14-350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Post-term pregnancy, a pregnancy exceeding 294 days or 42 completed weeks, is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour. However, there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy, leading to practice variation between caregivers. Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks. However, interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design. Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks, which does not reflect usual care in The Netherlands where induction of labour at 42 weeks is the regular policy. Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks. METHODS/DESIGN In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position. We will perform a multicenter randomised controlled clinical trial. Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity. Secondary outcomes will be maternal outcomes as mode of delivery (operative vaginal delivery and Caesarean section), need for analgesia and postpartum haemorrhage (≥1000 ml). Maternal preferences, satisfaction, wellbeing, pain and anxiety will be assessed alongside the trial. DISCUSSION This study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks. TRIAL REGISTRATION Dutch Trial Register (Nederlands Trial Register): NTR3431. Registered: 14 May 2012.
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Affiliation(s)
- Joep C Kortekaas
- />Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- />Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Aafke Bruinsma
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Judit KJ Keulen
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen van Dillen
- />Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn A Oudijk
- />Department of Obstetrics and Gynaecology, University Medical Center, Utrecht, the Netherlands
| | - Joost J Zwart
- />Department of Obstetrics and Gynaecology, Deventer Hospital, Deventer, the Netherlands
| | - Jannet JH Bakker
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Dokie de Bont
- />Midwifery practice ‘het Verloskundig Huys’, Zwolle, the Netherlands
| | - Marianne Nieuwenhuijze
- />Research Center for Midwifery Science, Faculty Midwifery Education & Studies Maastricht, ZUYD University, Heerlen, the Netherlands
| | - Pien M Offerhaus
- />KNOV (Royal Dutch Organisation for Midwives), Utrecht, the Netherlands
| | - Anton H van Kaam
- />Department of Neonatology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Vandenbussche
- />Department of Obstetrics & Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ben Willem J Mol
- />The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, 5000 SA Australia
| | - Esteriek de Miranda
- />Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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