Induction of labour for improving birth outcomes for women at or beyond term

Middleton, Philippa; Shepherd, Emily; Crowther, Caroline A

doi:10.1002/14651858.cd004945.pub4

Cited by 291 publications

(240 citation statements)

References 110 publications

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“…Relative birthweight and gestational age formulations also resolve the paradox of intersecting mortality curves . The mechanism by which these formulations eliminate the paradox may be explained using the fetuses‐at‐risk birth rate and the first derivative of the birth rate…”

Section: Commentmentioning

confidence: 99%

“…5,18 Non-causal models, which serve an important diagnostic or (non- Relative birthweight and gestational age formulations also resolve the paradox of intersecting mortality curves. [9][10][11][12][13][14][15]31 The mechanism by which these formulations eliminate the paradox may be explained using the fetuses-at-risk birth rate and the first derivative of the birth rate. 32 Collider stratification bias, [33][34][35] another explanation for the paradox, posits that perinatal mortality curves that intersect across any determinant contrast (eg twins vs singletons) are a consequence of stratification on a variable (eg gestational age) that is the common effect of the determinant in question and an unmeasured or unknown confounder (of the gestational age and perinatal death relation).…”

Section: Explanations For the Paradox In Contemporary Epidemiologymentioning

confidence: 99%

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Towards a unified perinatal theory: Reconciling the births‐based and fetus‐at‐risk models of perinatal mortality

Joseph

2019

Paediatric Perinatal Epid

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Background There is a need to reconcile the opposing perspectives of the births‐based and fetuses‐at‐risk models of perinatal mortality and to formulate a coherent and unified perinatal theory. Methods Information on births in the United States from 2004 to 2015 was used to calculate gestational age‐specific perinatal death rates for low‐ and high‐risk cohorts. Cubic splines were fitted to the fetuses‐at‐risk birth and perinatal death rates, and first and second derivatives were estimated. Births‐based perinatal death rates, and fetuses‐at‐risk birth and perinatal death rates and their derivatives, were examined to identify potential inter‐relationships. Results The rate of change in the birth rate dictated the pattern of births‐based perinatal death rates in a triphasic manner: increases in the first derivative of the birth rate at early gestation corresponded with exponential declines in perinatal death rates, the peak in the first derivative presaged the nadir in perinatal death rates, and late gestation declines in the first derivative coincided with an upturn in perinatal death rates. Late gestation increases in the first derivative of the fetuses‐at‐risk perinatal death rate matched the upturn in births‐based perinatal death rates. Differences in birth rate acceleration/deceleration among low‐ and high‐risk cohorts resulted in intersecting perinatal mortality curves. Conclusion The first derivative of the birth rate links a cohort's fetuses‐at‐risk perinatal death rate to its births‐based perinatal death rate, and cohort‐specific differences in birth rate acceleration/deceleration are responsible for the intersecting perinatal mortality curves paradox. This mechanistic explanation unifies extant models of perinatal mortality and provides diverse insights.

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Section: Commentmentioning

confidence: 99%

Section: Explanations For the Paradox In Contemporary Epidemiologymentioning

confidence: 99%

Towards a unified perinatal theory: Reconciling the births‐based and fetus‐at‐risk models of perinatal mortality

Joseph

2019

Paediatric Perinatal Epid

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“…5 Evidence from randomised trials shows that early delivery reduces perinatal mortality among low-risk pregnancies at full-term and post-term gestation. 6,7 In highrisk pregnancies and emergency situations at earlier gestation (eg, pre-eclampsia with growth restriction and reversed end-diastolic umbilical artery flow, or placental abruption with fetal bradycardia), the risk-benefit equation could again favour early delivery. 5 In any case, the simplistic assumption that risks quantified in a descriptive model of perinatal mortality would remain unchanged despite intervention is a false premise.…”

Section: Fe Tus E S-at-ris K Pat Tern S Of Perinatal Mortalit Y Andmentioning

confidence: 99%

Exorcizing Yerushalmy’s ghost

Joseph

2019

Paediatric Perinatal Epid

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“…In this context, we excluded two otherwise eligible studies, one of them including only women with favorable 22 and one including only women with unfavorable 23 cervix score, as both of them would be at theoretical risk of selection bias. Our focus on singleton uncomplicated pregnancies at 39 weeks differentiates our meta-analysis from previous systematic reviews [34][35][36][37] , which analyzed term pregnancies (i.e. ≥ 37 weeks' gestation) as a group [34][35][36][37] , included all indications for induction in their main analyses [34][35][36][37] or assessed only the impact of induction on the rate of Cesarean section 34 .…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy: a meta‐analysis

Sotiriadis

Petousis

Thilaganathan

et al. 2018

Ultrasound in Obstet & Gyne

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Objective The rate of maternal and perinatal complications increases after 39 weeks' gestation in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the available evidence on the effect of elective induction of labor at 39 weeks on the risk of Cesarean section, and on maternal and perinatal outcomes. Methods PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases were searched from inception to August 2018. Additionally, the references of retrieved articles were searched. Eligible studies were randomized controlled trials of singleton uncomplicated pregnancies in which participants were randomized between 39 + 0 and 39 + 6 gestational weeks to either induction of labor or expectant management. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed according to the GRADE guideline. Primary outcomes included Cesarean section, maternal death and admission to the neonatal intensive care unit (NICU). Secondary outcomes included operative delivery, Grade‐3/4 perineal laceration, postpartum hemorrhage, maternal infection, hypertensive disease of pregnancy, maternal thrombotic events, length of maternal hospital stay, neonatal death, need for neonatal respiratory support, cerebral palsy, length of stay in NICU and length of neonatal hospital stay. Pooled risk ratios (RRs) were calculated using random‐effects models. Results The meta‐analysis included five studies (7261 cases). Induction of labor was associated with a decreased risk for Cesarean section (moderate quality of evidence; RR 0.86 (95% CI, 0.78–0.94); I2 = 0.1%), maternal hypertension (moderate quality of evidence; RR 0.65 (95% CI, 0.57–0.75); I2 = 0%) and neonatal respiratory support (moderate quality of evidence; RR 0.73 (95% CI, 0.58–0.95); I2 = 0%). Neonates born after induction weighed, on average, 81 g (95% CI, 63–100 g) less than those born after expectant management. No significant effects were found for the other outcomes with the available data. The main limitation of our analysis was that the majority of data were derived from a single large study. A second limitation arose from the open‐label design of the studies, which may theoretically have affected the readiness of the attending clinician to resort to Cesarean section. Conclusions Elective induction of labor in uncomplicated singleton pregnancy at 39 weeks' gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

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Induction of labour for improving birth outcomes for women at or beyond term

Cited by 291 publications

References 110 publications

Towards a unified perinatal theory: Reconciling the births‐based and fetus‐at‐risk models of perinatal mortality

Towards a unified perinatal theory: Reconciling the births‐based and fetus‐at‐risk models of perinatal mortality

Exorcizing Yerushalmy’s ghost

Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy: a meta‐analysis

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