Labor Induction Versus Expectant Management in Low-Risk Nulliparous Women

Grobman, William A.; Rice, Madeline Murguia; Reddy, Uma M.; Tita, Alan T.N.; Silver, Robert M.; Mallett, Gail; Hill, Kim; Thom, Elizabeth; El‐Sayed, Yasser Y.; Perez-Delboy, Annette; Rouse, Dwight J.; Saade, George R.; Boggess, Kim; Chauhan, Suneet P.; Iams, Jay D.; Chien, Edward K.; Casey, Brian M.; Gibbs, Ronald S.; Srinivas, Sindhu K.; Swamy, Geeta K.; Simhan, Hyagriv N.; Macones, George A.

doi:10.1097/01.ogx.0000550506.01685.a7

Cited by 159 publications

(301 citation statements)

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“…Recent data on the benefit of labor induction at 39 weeks was not confirmed in our study. This could be explained by the particular profile of our population, as Grobman et al included low‐risk nulliparous women, but also by a lack of power.…”

Section: Discussioncontrasting

confidence: 97%

Risk factors for failed induction of labor among pregnant women with Class III obesity

Kerbage

Senat

Drumez

et al. 2020

Acta Obstet Gynecol Scand

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| INTRODUC TI ONObesity and overweight are currently a public health problem in France. The World Health Organization has described obesity according to three increasing classes of severity as a function of body mass index (BMI), Class I (30-34.9 kg/m 2 ), Class II (35-39.9 kg/m 2 ) and Class III (≥40 kg/m 2 ). This description is correlated with the numbers and severity of complications observed in these populations. The specific and nonspecific complications of obesity are numerous. Cardiovascular complications are those responsible for the highest morbidity. 1 In obstetrics, obesity leads to the risk of complications (preeclampsia, gestational diabetes, pregnancy-induced Abstract Introduction: Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. Material and methods: This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m 2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. Results: In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. Conclusions: In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score. K E Y W O R D S cesarean delivery, induction of labor, morbid obesity, obesity, pregnancy, vaginal delivery

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Section: Discussioncontrasting

confidence: 97%

Risk factors for failed induction of labor among pregnant women with Class III obesity

Kerbage

Senat

Drumez

et al. 2020

Acta Obstet Gynecol Scand

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“…The argument that the results of ARRIVE Trial cannot be generalised to an Australian setting is based on the observation that only 27% of eligible women agreed to participate, and relies on the assumption that the women who did not participate were less likely to benefit from IOL. It is not possible to determine what would have happened to these women and their babies, but there is evidence that the association between planned IOL at 39 weeks and fewer caesarean sections can be generalised.…”

Section: Generalisabilitymentioning

confidence: 99%

“…There are many points of agreement. All authors believed in a woman’s right to choose, that IOL prevents caesarean section and that the ARRIVE Trial (in isolation) did not show an improvement in perinatal outcomes.…”

mentioning

confidence: 99%

Informed decision making around induction of labour at 39 weeks

Vries

Gordon

2020

Aust NZ J Obst Gynaeco

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We recently argued the case for offering induction of labour (IOL) at 39 weeks gestational age to all women with a lowrisk pregnancy. 1 The purpose of this article is to respond to the authors of the other side of the debate. 2 There are many points of agreement. All authors believed in a woman's right to choose, that IOL prevents caesarean section and that the ARRIVE Trial 3 (in isolation) did not show an improvement in perinatal outcomes. GENERALISABILITYThe argument that the results of ARRIVE Trial 3 cannot be generalised to an Australian setting is based on the observation that only 27% of eligible women agreed to participate, and relies on the assumption that the women who did not participate were less likely to benefit from IOL. It is not possible to determine what would have happened to these women and their babies, but there is evidence that the association between planned IOL at 39 weeks and fewer caesarean sections can be generalised.There was remarkable consistency of treatment effect among trials of IOL at 37-41 weeks pregnancy as evidenced by the low I 2 statistics of 0-25% in meta-analyses. [4][5][6][7] This indicates a consistent effect of IOL on caesarean section rates across a wide range of populations.In the ARRIVE Trial there was no evidence of interaction between age or body mass index and planned IOL, meaning that the treatment effect of IOL appeared to be similar for older versus younger and heavier versus lighter women, also supporting generalisability of the study's findings. COST-EFFECTIVENESSDespite our contention that IOL is 'cheap', the limited literature do suggest that IOL is more expensive than a vaginal birth. 8-10 However, the costs of AU$5876-6524 per IOL in Australia or >€3000 in the Netherlands 8,9 quoted by Nippita et al. are misleading because, in these studies, they were not compared with the cost of the alternatives: a spontaneous vaginal birth or a caesarean section. According to the 2012-2013 National Efficient Price Determination (the same year as the data in the Australian study), the minimum costs are: 1. AU$4095 for a vaginal birth of minor complexity; and 2. AU$9989 for a caesarean section of minor complexity. 10 Thus, the difference in costs is likely to be less than AU$2000, especially when the potential cost-savings due to fewer caesarean sections are considered. Further, options such as outpatient cervical ripening could further reduce the costs of IOL and there is evidence that women prefer this option. 11The US study by Hersh et al. (2019) found that IOL for low-risk nulliparous women was cost-effective 9 and thus, on the basis of the available evidence, there is no compelling economic argument not to offer IOL at 39 weeks to low-risk nulliparous women. IOL IMPROVES PERINATAL OUTCOMESNippita et al. state correctly that in the ARRIVE Trial, there was no significant difference in perinatal outcomes. However, the Pvalue of 0.049 was of borderline statistical significance and there

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“…Dr Walsh has spotted a typo in the text – the percentage reduction in adverse perinatal outcomes is 20.3% not 23% in the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial . We did not comment on statistical significance, but given that one of the statistical tests was of borderline significance, at the 5% level, and the other was statistically significant, we think that our brief statement that ‘perinatal adverse outcomes [were] reduced’ is reasonable.…”

mentioning

confidence: 92%