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Hu Y, Homer CSE, Ellwood D, Slavin V, Vogel JP, Enticott J, Callander EJ. Likelihood of primary cesarean section following induction of labor in singleton cephalic pregnancies at term, compared with expectant management: An Australian population-based, historical cohort study. Acta Obstet Gynecol Scand 2024; 103:946-954. [PMID: 38291953 PMCID: PMC11019518 DOI: 10.1111/aogs.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/27/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION There has been increased use of both induction of labor (IOL) and cesarean section for women with term pregnancies in many high-income countries, and a trend toward birth at earlier gestational ages. Existing evidence regarding the association between IOL and cesarean section for term pregnancies is mixed and conflicting, and little evidence is available on the differential effect at each week of gestation, stratified by parity. MATERIAL AND METHODS To explore the association between IOL and primary cesarean section for singleton cephalic pregnancies at term, compared with two definitions of expectant management (first: at or beyond the week of gestation at birth following IOL; and secondary: only beyond the week of gestation at birth following IOL), we performed analyses of population-based historical cohort data on women who gave birth in one Australian state (Queensland), between July 1, 2012 and June 30, 2018. Women who gave birth before 37+0 or after 41+6 weeks of gestation, had stillbirths, no-labor, multiple births (twins or triplets), non-cephalic presentation at birth, a previous cesarean section, or missing data on included variables were excluded. Four sub-datasets were created for each week at birth (37-40). Unadjusted relative risk, adjusted relative risk using modified Poisson regression, and their 95% confidence intervals were calculated in each sub-dataset. Analyses were stratified by parity (nulliparas vs. parous women with a previous vaginal birth). Sensitivity analyses were conducted by limiting to women with low-risk pregnancies. RESULTS A total of 239 094 women were included in the analysis, 36.7% of whom gave birth following IOL. The likelihood of primary cesarean section following IOL in a Queensland population-based cohort was significantly higher at 38 and 39 weeks, compared with expectant management up to 41+6 weeks, for both nulliparas and paras with singleton cephalic pregnancies, regardless of risk status of pregnancy and definition of expectant management. No significant difference was found for nulliparas at 37 and 40 weeks; and for paras at 40 weeks. CONCLUSIONS Future studies are suggested to investigate further the association between IOL and other maternal and neonatal outcomes at each week of gestation in different maternal populations, before making any recommendation.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health ProgrammeBurnet InstituteMelbourneVictoriaAustralia
| | - David Ellwood
- School of Medicine & DentistryGriffith UniversityGold CoastQueenslandAustralia
- Gold Coast University Hospital, Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
| | - Valerie Slavin
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Gold Coast University Hospital, Gold Coast Hospital and Health ServiceSouthportQueenslandAustralia
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health ProgrammeBurnet InstituteMelbourneVictoriaAustralia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Emily J. Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- School of Public HealthUniversity of Technology SydneySydneyNew SouthAustralia
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Place K, Rahkonen L, Tekay A, Väyrynen K, Orden M, Vääräsmäki M, Uotila J, Tihtonen K, Rinne K, Mäkikallio K, Heinonen S, Kruit H. Labor induction at 41 +0 gestational weeks or expectant management for the nulliparous woman: The Finnish randomized controlled multicenter trial. Acta Obstet Gynecol Scand 2024; 103:505-511. [PMID: 38112629 PMCID: PMC10867371 DOI: 10.1111/aogs.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Neonatal and maternal risks increase in term pregnancy as gestational age advances and become increasingly evident post-term. Management practices of late- and post-term pregnancies vary, and the optimal time point for intervention by labor induction is yet to be determined. MATERIAL AND METHODS This randomized controlled trial of 381 nulliparous women with unripe cervices compared labor induction at 41+0 gestational weeks (early induction) with expectant management and labor induction at 41+5 to 42+1 gestational weeks (expectant management). This multicenter study included all five university hospitals and the largest central hospital in Finland. The study period was 2018-2022. Participants were randomized to either early induction (48.8%, n = 186) or expectant management (51.2%, n = 195) with equal randomization ratios of 1:1. This was a superiority trial, and the primary outcomes were rates of cesarean section (CS) and composite of adverse neonatal outcomes. The trial was registered at the ISRCTN registry (ISRCTN83219789, https://doi.org/10.1186/ISRCTN83219789). RESULTS The rates of CS (16.7% [n = 31] vs. 24.1% [n = 47], RR 0.7 [95% CI: 0.5-1.0], p = 0.07) and a composite of adverse neonatal outcomes (9.7% [n = 18] vs. 14.4% [n = 28], RR 0.7 [95% CI: 0.4-1.2] p = 0.16) did not significantly differ between the groups, but the operative delivery rate was lower in the early induction group than in the expectant management group (30.6% [n = 57] vs. 45.6% [n = 89], p = 0.003). The rates of hemorrhage ≥1000 mL and neonatal weight ≥4000 g were also lower in the early induction group, as was the vacuum extraction rate in women with vaginal delivery. Of the women with expectant management, 45.6% (n = 89) had spontaneous onset of labor. No perinatal deaths occurred, but one case of eclampsia appeared in the expectant management group. CONCLUSIONS Offering labor induction to nulliparous women at 41+0 gestational weeks may decrease the probability of operative delivery, postpartum hemorrhage, and neonatal weight ≥4000 g. However, this study was underpowered to affirm the trends of rising rates of CS and adverse neonatal outcomes in the expectant management group. Thus, expectant management could remain an option for some, as one in two women with expectant management had a spontaneous onset of labor.
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Affiliation(s)
- Katariina Place
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Leena Rahkonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Aydin Tekay
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Kirsi Väyrynen
- Department of Obstetrics and GynecologyCentral Finland Central HospitalJyväskyläFinland
| | - Maija‐Riitta Orden
- Department of Obstetrics and GynecologyKuopio University Hospital and University of Eastern FinlandKuopioFinland
| | - Marja Vääräsmäki
- Clinical Medicine Research Unit, Department of Obstetrics and Gynecology, Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Jukka Uotila
- Department of Obstetrics and GynecologyTampere University Hospital and Tampere UniversityTampereFinland
| | - Kati Tihtonen
- Department of Obstetrics and GynecologyTampere University Hospital and Tampere UniversityTampereFinland
| | - Kirsi Rinne
- Department of Obstetrics and GynecologyTurku University Hospital and University of TurkuTurkuFinland
| | - Kaarin Mäkikallio
- Department of Obstetrics and GynecologyTurku University Hospital and University of TurkuTurkuFinland
| | - Seppo Heinonen
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Heidi Kruit
- Department of Obstetrics and GynecologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Artieta-Pinedo I, Paz-Pascual C, Garcia-Alvarez A, Bully P, Espinosa M. Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth. BMC Womens Health 2024; 24:42. [PMID: 38225596 PMCID: PMC10789003 DOI: 10.1186/s12905-023-02856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics. METHODS The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability. RESULTS Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important. CONCLUSIONS Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.
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Affiliation(s)
- Isabel Artieta-Pinedo
- Primary Care Midwife OSI Barakaldo Sestao, Osakidetza, Barakaldo, Spain.
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain.
- Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Basque, Bizkaia, Spain.
| | - Carmen Paz-Pascual
- Primary Care Midwife OSI Barakaldo Sestao, Osakidetza, Barakaldo, Spain
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Midwifery Training Unit of Basque Country, Bilbao, Spain
| | - Arturo Garcia-Alvarez
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Servicio Vasco de Salud-Osakidetza, Vitoria-Gasteiz, Alava, Spain
| | - Paola Bully
- Methodological and Statistical Consulting, Sopuerta, Bizkaia, Spain
| | - Maite Espinosa
- Biobizkaia Health Research Institute, Plaza de Cruces 1, 48903, Bizkaia, Barakaldo, Spain
- Servicio Vasco de Salud-Osakidetza, Vitoria-Gasteiz, Alava, Spain
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Davies-Tuck ML, Davey MA, Hodges RL, Wallace EM. Fetal surveillance from 39 weeks' gestation to reduce stillbirth in South Asian-born women. Am J Obstet Gynecol 2023; 229:286.e1-286.e9. [PMID: 36907532 DOI: 10.1016/j.ajog.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND In July 2017, the State of Victoria's largest maternity service implemented a new clinical guideline to reduce the rates of stillbirth at term for South Asian women. OBJECTIVE This study aimed to evaluate the impact of offering fetal surveillance from 39 weeks to South Asian-born women on rates of stillbirth and neonatal and obstetrical interventions. STUDY DESIGN This was a cohort study of all women receiving antenatal care at 3 large metropolitan university-affiliated teaching hospitals in Victoria, who gave birth in the term period between January 2016 and December 2020. Differences in rates of stillbirth, neonatal deaths, perinatal morbidities, and interventions after July 2017 were determined. Multigroup interrupted time-series analysis was used to assess changes in rates of stillbirth and induction of labor. RESULTS A total of 3506 South Asian-born women gave birth before, and 8532 after the change in practice. There was a 64% reduction in term stillbirth (95% confidence interval, 87% to 2%; P=.047) after the change in practice from 2.3 per 1000 births to 0.8 per 1000 births. The rates of early neonatal death (3.1/1000 vs 1.3/1000; P=.03) and special care nursery admission (16.5% vs 11.1%; P<.001) also decreased. There were no significant differences in admission to the neonatal intensive care unit, 5-minute Apgar score <7, or birthweight, or differences in the trends of induction of labor per month. CONCLUSION Fetal monitoring from 39 weeks may offer an alternative to routine earlier induction of labor to reduce the rates of stillbirth without causing an increase in neonatal morbidity and attenuating trends in obstetrical interventions.
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Affiliation(s)
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Ryan L Hodges
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash Health, Clayton, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Department of Health and Human Services, Melbourne, Australia
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Offerhaus P, van Haaren-Ten Haken TM, Keulen JKJ, de Jong JD, Brabers AEM, Verhoeven CJM, Scheepers HCJ, Nieuwenhuijze M. Regional practice variation in induction of labor in the Netherlands: Does it matter? A multilevel analysis of the association between induction rates and perinatal and maternal outcomes. PLoS One 2023; 18:e0286863. [PMID: 37289749 PMCID: PMC10249899 DOI: 10.1371/journal.pone.0286863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Practice variation in healthcare is a complex issue. We focused on practice variation in induction of labor between maternity care networks in the Netherlands. These collaborations of hospitals and midwifery practices are jointly responsible for providing high-quality maternity care. We explored the association between induction rates and maternal and perinatal outcomes. METHODS In a retrospective population-based cohort study, we included records of 184,422 women who had a singleton, vertex birth of their first child after a gestation of at least 37 weeks in the years 2016-2018. We calculated induction rates for each maternity care network. We divided networks in induction rate categories: lowest (Q1), moderate (Q2-3) and highest quartile (Q4). We explored the association of these categories with unplanned caesarean sections, unfavorable maternal outcomes and adverse perinatal outcomes using descriptive statistics and multilevel logistic regression analysis corrected for population characteristics. FINDINGS The induction rate ranged from 14.3% to 41.1% (mean 24.4%, SD 5.3). Women in Q1 had fewer unplanned caesarean sections (Q1: 10.2%, Q2-3: 12.1%; Q4: 12.8%), less unfavorable maternal outcomes (Q1: 33.8%; Q2-3: 35.7%; Q4: 36.3%) and less adverse perinatal outcomes (Q1: 1.0%; Q2-3: 1.1%; Q4: 1.3%). The multilevel analysis showed a lower unplanned caesarean section rate in Q1 in comparison with reference category Q2-3 (OR 0.83; p = .009). The unplanned caesarean section rate in Q4 was similar to the reference category. No significant associations with unfavorable maternal or adverse perinatal outcomes were observed. CONCLUSION Practice variation in labor induction is high in Dutch maternity care networks, with limited association with maternal outcomes and no association with perinatal outcomes. Networks with low induction rates had lower unplanned caesarean section rates compared to networks with moderate rates. Further in-depth research is necessary to understand the mechanisms that contribute to practice variation and the observed association with unplanned caesarean sections.
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Affiliation(s)
- Pien Offerhaus
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | | | - Judit K. J. Keulen
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
| | - Judith D. de Jong
- Nivel–Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anne E. M. Brabers
- Nivel–Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Corine J. M. Verhoeven
- Department of Midwifery Science, Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, the Netherlands
| | - Hubertina C. J. Scheepers
- Department of Obstetrics and Gynecology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands
- Maastricht University, Care and Public Health Research Institute, Maastricht, the Netherlands
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Mauri PA, Pilloni E, Stillavato S, Ragusa A, Masturzo B, Trojano G, Piteri G, Pegurri G, Ricci ED, Teodoro MC, Guardalà F, Messina A, Svelato A, Parazzini F, Iurlaro E, Viora E. Role of mode of induction and delivery and women's satisfaction after induction of labour at term: An observational study. Eur J Obstet Gynecol Reprod Biol 2023; 286:47-51. [PMID: 37201318 DOI: 10.1016/j.ejogrb.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/20/2023]
Abstract
This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman' satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible for the study. The questionnaire investigated women's opinion regarding information about induction, pain control, length of induction, their experience about induction, labour and delivery and their attitude towards induction in a subsequent pregnancy. Women were also asked to fill in the Italian version of the Birth Satisfaction Scale-Revised (BSS-R). A total of 300 women entered the study. The answer to the question about a "positive attitude towards induction in a subsequent pregnancy was "absolutely yes" or "yes" respectively in the 77.8%, 52.8% and 48.6% of women who were induced with oral drugs, vaginal drugs and Cook balloon (heterogeneity chi-square p = 0.05). The corresponding values for women who delivered vaginally or by caesarean section (CS) were 63.3% and 36.4% (chi-square p = 0.0009). The mean BSS-R total score was higher among women who underwent IOL with oral drugs than with vaginal drugs (p < 0.0001) or Cook Balloon (p < 0.0001), and among women who delivered vaginally than in those who delivered by CS (p < 0.0001). Women were asked "What do you think is important for a method of induction?": 47.3% (95% CI 41.7%-53.0%) of women answered that "should make the induction as painless as possible", 47.0% (95% CI 41.4%-52.7%) "should induce labour quickly", 44.3% (95% CI 38.8%-50.0%) "should be safe for baby". This study showed that vaginal delivery was associated with a higher rate of satisfaction among induced women. Considering mode of induction, oral drugs were associated with a higher level of satisfaction. Control of pain and quick induction were the most appreciated characteristics.
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Affiliation(s)
- Paola Agnese Mauri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy; SITRA Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza 35, 20122 Milan, Italy.
| | - Eleonora Pilloni
- Obstetrics and Gynecology Department 3, Sant' Anna Hospital, Corso Spezia 60, 10126 Turin, Italy.
| | - Silvia Stillavato
- Obstetrics and Gynecology Department 3, Sant' Anna Hospital, Corso Spezia 60, 10126 Turin, Italy.
| | - Antonio Ragusa
- Department of Obstetrics and Gynecology, Università Campus Bio Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy.
| | - Bianca Masturzo
- Obstetrics and Gynecology Department, General Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Biella- University of Turin, Italy.
| | - Giuseppe Trojano
- Department of Maternal and Child Health "Madonna delle Grazie" Hospital ASM, Contrada Cattedra Ambulante, 75100 Matera, Italy.
| | - Giulia Piteri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Giorgia Pegurri
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Elena Delfina Ricci
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Maria Cristina Teodoro
- Department Maternal and Child Health, Obstetrics and Gynecology Unit, Hospital AO for Emergency Cannizzaro, via Messina 829, 95126 Catania, Italy.
| | - Fabio Guardalà
- Department Maternal and Child Health, Obstetrics and Gynecology Unit, Hospital AO for Emergency Cannizzaro, via Messina 829, 95126 Catania, Italy.
| | - Alessandro Messina
- Obstetrics and Gynecology Department, General Hospital, Via dei Ponderanesi 2, 13875 Ponderano, Biella- University of Turin, Italy.
| | - Alessandro Svelato
- Obstetric Pathology Unit Ospedale Fatebenefratelli Hospital, Gemelli-Isola Tiberina, via di Ponte Quattro capi 39, 00186 Rome, Italy.
| | - Fabio Parazzini
- Midwifery school, Department of Clinical Sciences and Community Health, University of Milan, via Manfredo Fanti 6, 20122 Milan, Italy.
| | - Enrico Iurlaro
- Obstetric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via della Commenda 12, 20122 Milan, Italy.
| | - Elsa Viora
- Associazione Ostetrici e Ginecologi Italiani, via Abamonti 1, 20129 Milan, Italy.
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Cost-effectiveness analysis of induction of labour at 41 weeks and expectant management until 42 weeks in low risk women (INDEX trial). Eur J Obstet Gynecol Reprod Biol X 2023; 17:100178. [PMID: 36755905 PMCID: PMC9900343 DOI: 10.1016/j.eurox.2023.100178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the cost-effectiveness of elective induction of labour (IOL) at 41 weeks and expectant management (EM) until 42 weeks. Design Cost-effectiveness analysis from a healthcare perspective alongside a randomised controlled trial (INDEX). Setting 123 primary care midwifery practices and 45 obstetric departments of hospitals in the Netherlands. Population We studied 1801 low-risk women with late-term pregnancy, randomised to IOL at 41 weeks (N = 900) or EM until 42 weeks (N = 901). Methods The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of the difference in costs and the difference in main perinatal outcomes. A Cost-Effectiveness Acceptability Curve (CEAC) was constructed to assess whether induction is cost-effective for a range of monetary values as thresholds. We performed subgroup analysis for parity. Main outcome measures Direct medical costs, composite adverse perinatal outcome (CAPO) (perinatal mortality, NICU admission, Apgar 5 min < 7, plexus brachialis injury and/or meconium aspiration syndrome) and composite severe adverse perinatal outcome (SAPO) (including Apgar 5 min < 4 instead of < 7). Results The average costs were €3858 in the induction group and €3723 in the expectant group (mean difference €135; 95 % CI -235 to 493). The ICERs of IOL compared to EM to prevent one additional CAPO and SAPO was €9436 and €14,994, respectively. The CEAC showed a 80 % chance of IOL being cost-effective with a willingness-to-pay of €22,000 for prevention of one CAPO and €50,000 for one SAPO. Subgroup analysis showed a willingness-to-pay to prevent one CAPO for nulliparous of €47,000 and for multiparous €190,000. To prevent one SAPO the willingness-to-pay is €62,000 for nulliparous and €970,000 for multiparous women. Conclusions Induction at 41 weeks has an 80 % chance of being cost-effective at a willingness-to-pay of €22,000 for prevention of one CAPO and €50,000 for prevention of one SAPO. Subgroup analysis suggests that induction could be cost-effective for nulliparous women while it is unlikely cost-effective for multiparous women.Cost-effectiveness in other settings will depend on baseline characteristics of the population and health system organisation and funding.
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Nilvér H, Lundgren I, Elden H, Dencker A. Women's lived experiences of induction of labour in late- and post-term pregnancy within the Swedish post-term induction study - a phenomenological study. Int J Qual Stud Health Well-being 2022; 17:2056958. [PMID: 35403573 PMCID: PMC9004499 DOI: 10.1080/17482631.2022.2056958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE There is a trend worldwide to induce pregnant women earlier. However, few studies have focused on women's experiences. The aim was to gain a deeper understanding of women's lived experiences of induction of labour in late- and post-term pregnancy. METHODS Phenomenology with a reflective lifeworld approach was chosen as the method. Twelve women participating in a larger study in which women were randomized to either induction of labour in week 41 or to expectant management until week 42, were interviewed one to three months after giving birth. RESULTS The essence is described as follows: labour becomes another journey than the intended one. The women adapted to this new journey by seeing the advantages and handing themselves over to the healthcare system, but at the same time something about giving birth could be lost. The result is further described by its four constituents: planning the unplannable, being a guest at the labour ward, someone else controlling the labour, and overshadowed by how it turned out. CONCLUSION Induced labour presents a challenge to maternity personnel to support the birthing woman's normal progress, not to rush her through labour, and to involve her in the process.
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Affiliation(s)
- Helena Nilvér
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Health and Care Sciences, The Arctic University of Norway, Tromsö, Norway
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bruinsma A, Keulen JKJ, Kortekaas JC, van Dillen J, Duijnhoven RG, Bossuyt PMM, van Kaam AH, van der Post JAM, Mol BW, de Miranda E. Elective induction of labour and expectant management in late-term pregnancy: A prospective cohort study alongside the INDEX randomised controlled trial. Eur J Obstet Gynecol Reprod Biol X 2022; 16:100165. [PMID: 36262791 PMCID: PMC9574420 DOI: 10.1016/j.eurox.2022.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/21/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy. Design Multicentre prospective cohort study alongside RCT. Setting 90 midwifery practices and 12 hospitals in the Netherlands. Population 3642 low-risk women with uncomplicated singleton late-term pregnancy. Main outcome measures Composite adverse outcome (perinatal death, Apgar score 5′ < 7, NICU admission, meconium aspiration syndrome), composite severe adverse perinatal outcome (all above with Apgar score 5′ < 4 instead of < 7) and caesarean section. Results From 2012–2016, 3642 women out of 6088 eligible women for the INDEX RCT, participated in the cohort study for observational data collection (induction of labour n = 372; expectant management n = 2174; unknown preference/management strategy n = 1096). Adverse perinatal outcome occurred in 1.1 % (4/372) in the induction group versus 1.9 % (42/2174) in the expectant group (adjRR 0.56; 95 %CI: 0.17–1.79), with severe adverse perinatal outcome occurring in 0.3 % (1/372) versus 1.0 % (22/2174), respectively (adjRR 0.39; 95 % CI: 0.05–2.88). There were no stillbirths among all 3642 women; one neonatal death occurred in the unknown preference/management group. Caesarean section rates were 10.5 % (39/372) after induction and 8.9 % (193/2174) after expectant management (adjRR 1.32; 95 % CI: 0.95–1.84). A higher incidence of adverse perinatal outcome was observed in nulliparous compared to multiparous women. Nulliparous 1.8 % (3/170) in the induction group versus 2.6 % (30/1134) in the expectant management group (adjRR 0.58; 95 % CI 0.14–2.41), multiparous 0.5 % (1/201) versus 1.1 % (11/1039) (adjRR 0.54; 95 % CI 0.07–24.19). One maternal death due to amniotic fluid embolism occurred after elective induction at 41 weeks + 6 days. Conclusion In this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1 % versus 1.9 %) and severe adverse (0.3 % versus 1.0 %) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3642 women. Caesarean section rates were comparable. No stillbirths in late-term pregnancy (IOL or EM) of 3642 women in INDEX-cohort. Less adverse perinatal outcomes in INDEX-cohort than in trial with comparable risk difference. More women approaching late-term pregnancy prefer EM, not elective induction.
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Affiliation(s)
- Aafke Bruinsma
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands,Rotterdam University of Applied Sciences, School of Midwifery, Rochussenstraat 198, Rotterdam, the Netherlands,Corresponding author at: Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Judit KJ Keulen
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands,Zuyd University, Research Center for Midwifery Science, Faculty Midwifery Education & Studies Maastricht, Universiteitssingel 60, Maastricht, the Netherlands
| | - Joep C Kortekaas
- Elkerliek Medical Center, Department of Obstetrics & Gynaecology, Wesselmanlaan 25, Helmond, the Netherlands
| | - Jeroen van Dillen
- Radboud University Medical Center, Department of Obstetrics & Gynaecology, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - Ruben G Duijnhoven
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Patrick MM Bossuyt
- Amsterdam UMC, University of Amsterdam, Department of Epidemiology & Data Science, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Amsterdam UMC, University of Amsterdam, Emma, Children’s hospital, Department of Neonatology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Joris AM van der Post
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ben W Mol
- Monash University, Department of Obstetrics and Gynaecology, 246 Clayton Road, Clayton, Victoria, Australia,University of Aberdeen, Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, AB24 3FX Aberdeen, UK
| | - Esteriek de Miranda
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
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Boutib A, Chergaoui S, Marfak A, Hilali A, Youlyouz-Marfak I. Quality of Life During Pregnancy from 2011 to 2021: Systematic Review. Int J Womens Health 2022; 14:975-1005. [PMID: 35941917 PMCID: PMC9356752 DOI: 10.2147/ijwh.s361643] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Health-related quality of life (HRQoL) has emerged as a key concern in patient care. It has become one of the major objectives of clinical trials. Our study aims to describe the quality of life (QoL) during uncomplicated pregnancy and to assess its associated factors. Patients and Methods The search of articles was carried out using the online database of PUBMED and Web of Science with a limit of time between 2011 and 2021. Data were retrieved by two independent reviewers. Results 721 publications responding to keywords were identified, of which 73 articles on the topic were selected. The main countries that have published on this subject are Australia (n = 10) and China (n = 7). Twenty-three articles deal with QoL for pathological pregnancies. All the pathologies studied have a negative impact on the HRQoL of pregnant women, and its improvement depends on the type of treatment. Obesity, low back, and pelvic girdle pain, and hyperemesis gravidarum were the frequent pathologies during pregnancy. Socio-demographic characteristics related to improved well-being (favorable economic status, social support). Similarly, better sleep quality and moderate physical exercise were linked to an increased QoL. Physical and psychological factors were associated with a lower QoL. Conclusion The HRQoL refers to patients’ subjective evaluation of physical, mental, and social components of well-being. Optimizing the QoL during pregnancy necessitates a deeper understanding of their issues as well as counseling which provides support wherever needed.
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Affiliation(s)
- Amal Boutib
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Samia Chergaoui
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Abdelghafour Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- National School of Public Health, Rabat, Morocco
| | - Abderraouf Hilali
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
| | - Ibtissam Youlyouz-Marfak
- Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco
- Correspondence: Ibtissam Youlyouz-Marfak, Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, 26000, Morocco, Tel +212 6 61 60 43 58, Fax +212 5 23 40 01 87, Email
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11
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Croll DMR, Meuleman T, de Heus R, de Boer MA, Verhoeven CJM, Bloemenkamp KWM, van Dillen J. Pregnant women's willingness to participate in a randomized trial comparing induction of labor at 39 weeks versus expectant management: A survey in the Netherlands. Eur J Obstet Gynecol Reprod Biol 2022; 273:7-11. [PMID: 35436644 DOI: 10.1016/j.ejogrb.2022.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION A randomized controlled trial (RCT) in the United States, the ARRIVE trial, has indicated that induction of labor (IOL) in low-risk nulliparous women with a gestational age (GA) of 39 weeks compared to expectant management (EM) resulted in a significant lower rate of cesarean deliveries. The Dutch maternity care system is different compared to the United States with, among other factors, an overall significantly lower percentage of caesarean sections (CS). To investigate whether IOL has a favorable outcome in the Dutch maternity care system, a new trial is advised. In this questionnaire-based study we aim to evaluate whether Dutch low-risk pregnant women would be willing to participate in an RCT comparing IOL at 39 weeks to EM. MATERIALS AND METHODS We conducted an online survey in 2020 in the Netherlands. Respondent recruitment took place both in outpatient clinics at hospitals and midwife practices and via social media. Inclusion criteria were pregnant women with singleton gestation, GA ≤ 39 weeks, age 18 years or older and residency in the Netherlands. Exclusion criteria were multiple gestation, a history of a CS, planned IOL or CS in current pregnancy and GA > 39 weeks. A subgroup was formed of low risk (receiving primary care) nulliparous women with a gestational age between 34 and 39 weeks, comparable with the ARRIVE trial. RESULTS Three hundred eighty respondents participated. Of all respondents (nulli- and multiparous), 47 (12.4%) would be willing to participate in the hypothetical RCT and 70 (18.4%) might be willing to participate. Amongst the 70 women in the subgroup 11 women (15.7%) would be willing to participate and 17 (24.3%) might be willing to participate. DISCUSSION AND CONCLUSION Calculating sample size in a country with a low CS rate, in relation to 69.2% of women are not willing to participate in an RCT comparing IOL at 39 weeks with EM, would require >18.000 women to be counselled for participation. We believe such a study is a challenge in the Netherlands.
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Affiliation(s)
- Dorothée M R Croll
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands.
| | - Tessa Meuleman
- Radboud Medical Centre, Department of Obstetrics, Nijmegen, the Netherlands
| | - Roel de Heus
- St. Antonius Hospital, Department of Gynecology & Obstetrics, Utrecht, the Netherlands
| | - Marjon A de Boer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Pregnancy and Birth, Amsterdam, the Netherlands
| | - Corine J M Verhoeven
- Amsterdam UMC, Location VUmc, Midwifery Science, AVAG, APH Research Institute, Amsterdam, the Netherlands; Division of Midwifery, School of Health Sciences, University of Nottingham, United Kingdom; Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, the Netherlands
| | - Kitty W M Bloemenkamp
- Wilhelmina's Children Hospital, UMC Utrecht, Department of Obstetrics, Division Woman and Baby, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Radboud Medical Centre, Department of Obstetrics, Nijmegen, the Netherlands
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Nilvér H, Wessberg A, Dencker A, Hagberg H, Wennerholm UB, Fadl H, Wesström J, Sengpiel V, Lundgren I, Bergh C, Wikström AK, Saltvedt S, Elden H. Women's childbirth experiences in the Swedish Post-term Induction Study (SWEPIS): a multicentre, randomised, controlled trial. BMJ Open 2021; 11:e042340. [PMID: 33827832 PMCID: PMC8031013 DOI: 10.1136/bmjopen-2020-042340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare childbirth experiences in women randomly assigned to either induction of labour at 41 weeks or to expectant management until 42 weeks, in the Swedish Post-term Induction Study. DESIGN A register-based, multicentre, randomised, controlled, superiority trial. SETTING Women were recruited at 14 hospitals in Sweden, 2016-2018. PARTICIPANTS Women with an uncomplicated singleton pregnancy were recruited at 41 gestational weeks. INTERVENTIONS The women were randomly assigned to induction of labour at 41 weeks (induction group, n=1381) or expectant management until 42 weeks (expectant management group, n=1379). OUTCOME MEASURES As main outcome, women's childbirth experiences were measured using the Childbirth Experience Questionnaire version 2 (CEQ2), in 656 women, 3 months after the birth at three hospitals. As exploratory outcome, overall childbirth experience was measured in 1457 women using a Visual Analogue Scale (VAS 1-10) within 3 days after delivery at the remaining eleven hospitals. RESULTS The total response rate was 77% (2113/2760). There were no significant differences in childbirth experience measured with CEQ2 between the groups (induction group, n=354; expectant management group, n=302) in the subscales: own capacity (2.8 vs 2.7, p=0.09), perceived safety (3.3 vs 3.2, p=0.06) and professional support (3.6 vs 3.5, p=0.38) or in the total CEQ2 score (3.3 vs 3.2, p=0.07), respectively. Women in the induction group scored higher in the subscale participation (3.6 vs 3.4, p=0.02), although with a small effect size (0.19). No significant difference was observed in overall childbirth experience according to VAS (8.0 (n=735) vs 8.1 (n=735), p=0.22). CONCLUSIONS There were no differences in childbirth experience, according to CEQ2 or overall childbirth experience assessed with VAS, between women randomly assigned to induction of labour at 41 weeks or expectant management until 42 weeks. Overall, women rated their childbirth experiences high. TRIAL REGISTRATION NUMBER ISRCTN26113652.
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Affiliation(s)
- Helena Nilvér
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
| | - Anna Wessberg
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
| | - Henrik Hagberg
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
- Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
| | - Ulla-Britt Wennerholm
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
- Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
| | - Helena Fadl
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jan Wesström
- Centre for Clinical Research, Department of Women's Health, Dalarna County Council, Falun, Sweden
| | - Verena Sengpiel
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
- Centre of Perinatal Medicine & Health, Institute of Clinical Sciences, Salgrenska Akademy, Göteborgs Universitet, Gothenbourg, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
| | - Christina Bergh
- Department of Reproductive Medicine, Sahlgrenska University Hospital, Gothenbourg, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sissel Saltvedt
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Akademy, University of Gothenbourg, Gothenbourg, Sweden
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenbourg, Sweden
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