Table 4

Impact of elective induction of labour versus expectant management on stillbirths and perinatal mortality

Source

Location and Type of Study

Intervention

Stillbirths/Perinatal Outcomes


Reviews and meta-analyses


Dare et al. 2006 [67]

Canada, Scotland, Netherlands, Israel, other countries.

Meta-analysis (Cochrane). 5 RCTs included (N = 5870 participants).

To assess the effects of planned early birth (intervention) vs. expectant management (controls) for women with term pre-labour rupture of membranes on fetal, infant and maternal wellbeing.

Fetal death (miscarriage + SB)/PMR: OR = 0.46 (95% CI: 0.13–1.66) [NS].

[3/2946 vs. 7/2924 in intervention and control groups, respectively].


Dodd et al. 2003 [70]

Japan (Tokyo).

Cochrane review. 1 RCT included (N = 72 participants).

To assess a policy of elective delivery from 37 weeks' gestation (intervention) vs. an expectant approach (controls) for women with an otherwise uncomplicated twin pregnancy.

PMR: RR not estimable.

[0/34 vs. 0/38 in intervention and control groups, respectively].


Gülmezoglu et al. 2006 [64]

Thailand, USA, Turkey, Norway, Canada, UK, India, Finland, China.

Meta-analysis (Cochrane). 12 RCTs included (N = 5939 women).

To assess the impact of a policy of labour induction at term or post-term (intervention) vs. awaiting spontaneous labour or later induction of labour (controls).

SBR: RR = 0.28 (95% CI: 0.05–1.67) [NS].

[0/2986 vs. 4/2953 in intervention and control groups, respectively].

PMR: RR = 0.30 (95% CI: 0.09–0.99).

[1/2986 vs. 9/2953 in intervention and control groups, respectively].


Irion et al. 1998 [63]

USA, unknown.

Meta-analysis (Cochrane). 2 RCTs included (N = 99 women).

To assess the effects of a policy of labour induction (intervention) vs. expectant management (controls) for suspected fetal macrosomia on method of delivery and maternal or perinatal morbidity.

PMR: RR not estimable.

[0/49 vs. 0/50 in intervention and control groups, respectively].


Boulvain et al. 2001 [65]

USA.

Cochrane review. 1 RCT included (N = 200 women).

To assess the effect of a policy of elective delivery (intervention) vs. expectant management (controls) in term diabetic pregnant women, on maternal and perinatal mortality and morbidity.

PMR: RR not estimable.

[0/100 vs. 0/100 in intervention and control groups, respectively].


Intervention studies


Chattopadhyay et al. 1986 [71]

Saudi Arabia.

Prospective, controlled study. Grand multiparae (N = 300) between 38 and 42 weeks' gestation (N = 150 intervention group, N = 150 controls).

To compare the impact on labour characteristics and outcome in women where labour was electively induced by intracervical prostaglandin E2 tablets (intervention) vs. women who went into labour spontaneously.

SBR: 0/150 vs. 4/150 in intervention and control groups, respectively.

Mean duration of the active phase of labour: 2.1 +/- 0.79 h vs. 2.8 +/- 0.47 h vs. 4.7 +/- 2.2 h in women who delivered on the first day of induction vs. on the second day vs. the controls.

Similarly, the mean duration of the second and third stage was longer in the controls.


da Graca Krupa et al. 2005 [69]

Brazil (Campinas City). Public university hospital.

RCT. N = 150 pregnancies, half of them allocated to each group.

To compare the effectiveness of immediate induction of labour with vaginal misoprostol (intervention) vs. expectant management for 24 hours followed by oxytocin induction (controls) in women with premature rupture of membranes at term (term PROM).

PMR: 0/75 in each group.


Observational studies


Duff et al. 2000 [150]

Ireland. Northern Ireland Maternity System (NIMATS).

Retrospective comparative study. N = 3262 women who delivered during 1994 – 96 (N = 1008 intervention group, N = 2254 controls).

Compared the impact on Caesarean section rates and Apgar scores in women who had labour induced (intervention) vs. those in whom the labour commenced spontaneously (controls).

Caesarean section rate: 12.2% vs. 7.06% in intervention and control groups, respectively [NS] (Chi sq = 4.39, p <= 0.2).

1 minute Apgar score: 7.78 vs. 7.9 in intervention and control groups, respectively, t = 2.9, P <= 0.01.

5 minute Apgar score: 8.99 vs. 9.05 in intervention and control groups, respectively, t = 2.42, P <= 0.02).


Darmstadt et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S6   doi:10.1186/1471-2393-9-S1-S6

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