Comparison of two policies for induction of labour postdates

Abstract

The objective of this study was to compare maternal and midwifery manpower effects of policies for induction of labour (IOL) postdates, using a retrospective cohort design, in a level two maternity unit in a district hospital in South-West England. Primary outcome measures included mode of delivery, admission-delivery interval, midwifery manpower use. Group I consisted of 124 women who underwent IOL at 40+10. Group II were 104 women who underwent IOL at 42 weeks' gestation and 123 women who laboured spontaneously between 40+10 and 42 weeks' gestation. The nulliparous women had a shorter admission-delivery interval when induction was planned for 42 weeks, compared with 40+10 (p = 0.003), and required less frequent use of syntocinon (p = 0.04) and of continuous fetal monitoring (p = 0.02). The caesarean rate was higher in Group I than in Group II (p = 0.04) for nulliparous women only. The earlier induction policy was associated with a higher midwifery manpower requirement for nulliparae (p = 0.002). For parous women, the only difference was the greater use of oxytocin in labour. There was no difference between the groups in duration of labour, analgesia, Apgar scores, admission to neonatal care and meconium aspiration. In conclusion, delaying planned induction by three days was associated with lower medicalisation of labour and manpower needs for nulliparous women.

Does a policy of earlier induction affect labour outcomes in women induced for postmaturity? A retrospective analysis in a tertiary hospital in the North of England

“…Similar studies comparing two different timings of induction and the effect on these outcomes are limited with contradictory findings. A UK based study found no difference in the length of labour in multiparous women induced at 40 weeks plus 10 days compared with women induced at 42 weeks (Kassab et al, 2011). This finding supports the current study and may reflect the comparable NHS hospital study populations where care is likely to be similar.…”

“…Some studies evaluating other outcomes have found that a policy of induction during 41 weeks gestation, compared with a policy of later induction at 42 weeks, may be associated with some adverse outcomes including increased caesarean sections (Kassab et al, 2011;Burgos et al, 2012), increased epidural use (Fok et al, 2006) and more newborns with low cord pH (Burgos et al, 2012). However, a recent much larger study has found that induction at 41 weeks and 5 days, rather than 42 weeks, was associated with decreased caesarean sections (Kjeldsen et al, 2015).…”

A systematic scoping review of clinical indications for induction of labour

“…There were 15 studies related to IOL for post-term pregnancy (> 40 weeks). These included a Cochrane review [6], a systematic review [34], an RCT [35], a prospective cohort study [36], nine retrospective cohort studies [37][38][39][40][41][42][43][44][45], and two secondary analyses of cohort studies [46,47]. The Cochrane review assessed the effects of a policy of IOL at or beyond term compared with a policy of awaiting spontaneous labour (or until planned birth is deemed necessary) on maternal and neonatal outcomes [6].…”

“…The remaining studies were cohort studies, mostly assessed as of moderate or severe risk of bias. In relation to outcomes associated with IOL at different gestational ages, three included retrospective cohort studies compared outcomes under different policy periods [38,41,45]. Bleicher et al [41] compared outcomes for women who gave birth under a policy of IOL at 42 weeks (n = 968; from 2008-2009) with those who gave birth under a policy of IOL at 41 weeks (n = 962; from 2012-2013).…”

Letter from Europe: Kick-starting the Uterus

“…A study of induced births on women having their first babies reported increased cesarean rates, postpartum hemorrhage, the need for resuscitation of the newborn, and longer stays in hospital‐‐‐all this without any improvements in neonatal outcomes (9). Limiting induction to women who have already reached 42 weeks, instead of inducing 10 days after the due date, cuts the induction rate and stimulation of labor once it has started, entails fewer other interventions, and, for those having a first baby, results in a lower cesarean section rate and less medicalized labors and “manpower needs” (10). (I suspect this is mostly woman power.)…”