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BMC Public Health
Published in: BMC Public Health 3/2011

Open Access 01-12-2011 | Review

Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis

Authors: Arwa Abbas Hussain, Mohammad Yawar Yakoob, Aamer Imdad, Zulfiqar A Bhutta

Published in: BMC Public Health | Special Issue 3/2011

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Abstract

Background

An important determinant of pregnancy outcome is the timely onset of labor and birth. Prolonged gestation complicates 5% to 10% of all pregnancies and confers increased risk to both the fetus and mother. The purpose of this review was to study the possible impact of induction of labour (IOL) for post-term pregnancies compared to expectant management on stillbirths.

Methods

A systematic review of the published studies including randomized controlled trials, quasi- randomized trials and observational studies was conducted. Search engines used were PubMed, the Cochrane Library, the WHO regional databases and hand search of bibliographies. A standardized data abstraction sheet was used. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by the Child Health Epidemiology Reference Group (CHERG).

Results

A total of 25 studies were included in this review. Meta-analysis of 14 randomized controlled trials (RCTs) suggests that a policy of elective IOL for pregnancies at or beyond 41 weeks is associated with significantly fewer perinatal deaths (RR=0.31; 95% CI: 0.11-0.88) compared to expectant management, but no significant difference in the incidence of stillbirth (RR= 0.29; 95% CI: 0.06-1.38) was noted. The included trials evaluating this intervention were small, with few events in the intervention and control group. There was significant decrease in incidence of neonatal morbidity from meconium aspiration (RR = 0.43, 95% CI 0.23-0.79) and macrosomia (RR = 0.72; 95% CI: 0.54 – 0.98). Using CHERG rules, we recommended 69% reduction as a point estimate for the risk of stillbirth with IOL for prolonged gestation (> 41 weeks).

Conclusions

Induction of labour appears to be an effective way of reducing perinatal morbidity and mortality associated with post-term pregnancies. It should be offered to women with post-term pregnancies after discussing the benefits and risks of induction of labor.
Appendix
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Literature
1.
Olesen AW, Westergaard JG, Olsen J: Perinatal and maternal complications related to postterm delivery: a national register-based study, 1978-1993. Am J Obstet Gynecol. 2003, 189 (1): 222-227. 10.1067/mob.2003.446.CrossRefPubMed
2.
Norwitz ER, Snegovskikh VV, Caughey AB: Prolonged pregnancy: when should we intervene?. Clin Obstet Gynecol. 2007, 50 (2): 547-557. 10.1097/GRF.0b013e31804c9b11.CrossRefPubMed
3.
Gynecologists ACoOa: Management of Postterm Pregnancy. ACOG Practice Bulletin No 55. 2004, Washington, DC: ACOG
4.
Rosen MG, Dickinson JC: Management of post-term pregnancy. N Engl J Med. 1992, 326 (24): 1628-1629. 10.1056/NEJM199206113262409.CrossRefPubMed
5.
Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM: Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstet Gynecol. 2003, 101 (6): 1312-1318. 10.1016/S0029-7844(03)00342-9.CrossRefPubMed
6.
Divon MY, Haglund B, Nisell H, Otterblad PO, Westgren M: Fetal and neonatal mortality in the postterm pregnancy: the impact of gestational age and fetal growth restriction. Am J Obstet Gynecol. 1998, 178 (4): 726-731. 10.1016/S0002-9378(98)70482-X.CrossRefPubMed
7.
Rand L, Robinson JN, Economy KE, Norwitz ER: Post-term induction of labor revisited. Obstet Gynecol. 2000, 96 (5 Pt 1): 779-783. 10.1016/S0029-7844(00)01002-4.CrossRefPubMed
8.
Hilder L, Costeloe K, Thilaganathan B: Prolonged pregnancy: evaluating gestation-specific risks of fetal and infant mortality. Br J Obstet Gynaecol. 1998, 105 (2): 169-173. 10.1111/j.1471-0528.1998.tb10047.x.CrossRefPubMed
9.
Cotzias CS, Paterson-Brown S, Fisk NM: Prospective risk of unexplained stillbirth in singleton pregnancies at term: population based analysis. BMJ. 1999, 319 (7205): 287-288. 10.1136/bmj.319.7205.287.PubMedCentralCrossRefPubMed
10.
Gulmezoglu AM, Crowther CA, Middleton P: Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev. 2006, CD004945-4
11.
Canada MFMCotSoOaGo: Post-term pregnancy (committee opinion). SOGC clinical practice guidelines No 15. 1997
12.
Hollis B: Prolonged pregnancy. Curr Opin Obstet Gynecol. 2002, 14 (2): 203-207. 10.1097/00001703-200204000-00015.CrossRefPubMed
13.
Swift J: Routine induction of labour at 41 weeks gestation: nonsensus consensus. BJOG: an International Journal of Obstetrics and Gynaecology. 2002, 109: 485-491. 10.1111/j.1471-0528.2002.01004.x.CrossRef
14.
Mandruzzato G, Alfirevic Z, Chervenak F, Gruenebaum A, Heimstad R, Heinonen S, Levene M, Romero R, Salvesen K, Saugstad O, et al: Guidelines for the management of postterm pregnancy. J Perinat Med. 2010, 38 (2): 111-119. 10.1515/JPM.2010.057.PubMed
15.
Walker N, Fischer-Walker C, Bryce J, Bahl R, Cousens S: Standards for CHERG reviews of intervention effects on child survival. Int J Epidemiol. 2010, 39 (Suppl 1): i21-31. 10.1093/ije/dyq036.PubMedCentralCrossRefPubMed
16.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, et al: Grading quality of evidence and strength of recommendations. BMJ. 2004, 328 (7454): 1490-10.1136/bmj.328.7454.1490.CrossRefPubMed
17.
RevMan: The Cochrane Colloboration. Review Manager (RevMan) 5 for Windows. Oxford England. 2003
18.
19.
Augensen K, Bergsjo P, Eikeland T, Askvik K, Carlsen J: Randomised comparison of early versus late induction of labour in post-term pregnancy. Br Med J (Clin Res Ed). 1987, 294 (6581): 1192-1195. 10.1136/bmj.294.6581.1192.CrossRef
20.
Bergsjo P, Huang GD, Yu SQ, Gao ZZ, Bakketeig LS: Comparison of induced versus non-induced labor in post-term pregnancy. A randomized prospective study. Acta Obstet Gynecol Scand. 1989, 68 (8): 683-687. 10.3109/00016348909006139.CrossRefPubMed
21.
Chanrachakul B, Herabutya Y: Postterm with favorable cervix: is induction necessary?. Eur J Obstet Gynecol Reprod Biol. 2003, 106 (2): 154-157. 10.1016/S0301-2115(02)00243-9.CrossRefPubMed
22.
Dyson DC, Miller PD, Armstrong MA: Management of prolonged pregnancy: induction of labor versus antepartum fetal testing. Am J Obstet Gynecol. 1987, 156 (4): 928-934.CrossRefPubMed
23.
Gelisen O, Caliskan E, Dilbaz S, Ozdas E, Dilbaz B, Haberal A: Induction of labor with three different techniques at 41 weeks of gestation or spontaneous follow-up until 42 weeks in women with definitely unfavorable cervical scores. Eur J Obstet Gynecol Reprod Biol. 2005, 120 (2): 164-169. 10.1016/j.ejogrb.2004.08.013.CrossRefPubMed
24.
Hannah ME, Hannah WJ, Hellmann J, Hewson S, Milner R, Willan A: Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group. N Engl J Med. 1992, 326 (24): 1587-1592. 10.1056/NEJM199206113262402.CrossRefPubMed
25.
Heimstad R, Skogvoll E, Mattsson LA, Johansen OJ, Eik-Nes SH, Salvesen KA: Induction of labor or serial antenatal fetal monitoring in postterm pregnancy: a randomized controlled trial. Obstet Gynecol. 2007, 109 (3): 609-617. 10.1097/01.AOG.0000255665.77009.94.CrossRefPubMed
26.
Henry GR: A controlled trial of surgical induction of labour and amnioscopy in the management of prolonged pregnancy. J Obstet Gynaecol Br Commonw. 1969, 76 (9): 795-798. 10.1111/j.1471-0528.1969.tb06180.x.CrossRefPubMed
27.
Herabutya Y, Prasertsawat PO, Tongyai T, Isarangura Na Ayudthya N: Prolonged pregnancy: the management dilemma. Int J Gynaecol Obstet. 1992, 37 (4): 253-258. 10.1016/0020-7292(92)90325-D.CrossRefPubMed
28.
James C, George SS, Gaunekar N, Seshadri L: Management of prolonged pregnancy: a randomized trial of induction of labour and antepartum foetal monitoring. Natl Med J India. 2001, 14 (5): 270-273.PubMed
29.
Martin JN, Sessums JK, Howard P, Martin RW, Morrison JC: Alternative approaches to the management of gravidas with prolonged-postterm-postdate pregnancies. J Miss State Med Assoc. 1989, 30 (4): 105-111.PubMed
30.
A clinical trial of induction of labor versus expectant management in postterm pregnancy. The National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 1994, 170 (3): 716-723.
31.
Suikkari AM, Jalkanen M, Heiskala H, Koskela O: Prolonged pregnancy: induction or observation. Acta Obstetricia et Gynecologica Scandinavica Supplement. 1983, 116: 58-
32.
Ocon L, Hurtado R, Coteron JJ, Zubiria A, Ramirez O, Garcia JA: Prolonged pregnancy: procedure guidelines [Gestacion prolongada: pautas de actuacion]. Progresos de Obstetricia y Ginecologia. 1997, 40: 101-106.
33.
Witter FR, Weitz CM: A randomized trial of induction at 42 weeks gestation versus expectant management for postdates pregnancies. Am J Perinatol. 1987, 4 (3): 206-211. 10.1055/s-2007-999774.CrossRefPubMed
34.
Sahraoui W, Hajji S, Bibi M, Nouira M, Essaidi H, Khairi H: Management of pregnancies beyond forty-one week's gestation with an unfavorable cervix. J Gynecol Obstet Biol Reprod (Paris). 2005, 34 (5): 454-462. 10.1016/S0368-2315(05)82853-4.CrossRef
35.
Cardozo L, Fysh J, Pearce JM: Prolonged pregnancy: the management debate. Br Med J (Clin Res Ed). 1986, 293 (6554): 1059-1063. 10.1136/bmj.293.6554.1059.CrossRef
36.
Iqbal S: Management of prolonged pregnancy. J Coll Physicians Surg Pak. 2004, 14 (5): 274-277.PubMed
37.
Katz Z, Yemini M, Lancet M, Mogilner BM, Ben-Hur H, Caspi B: Non-aggressive management of post-date pregnancies. Eur J Obstet Gynecol Reprod Biol. 1983, 15 (2): 71-79. 10.1016/0028-2243(83)90175-2.CrossRefPubMed
38.
Al-Taani M: Pregnancies past the estimated date of confinement: labour and delivery outcome. East Mediterr Health J. 2003, 9 (5-6): 955-960.PubMed
39.
Bian X: Exploration of the clinical management of prolonged pregnancy. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 1990, 12 (2): 137-141.PubMed
40.
Hauth JC, Goodman MT, Gilstrap LC, Gilstrap JE: Post-term pregnancy. I. Obstet Gynecol. 1980, 56 (4): 467-470.PubMed
41.
Maly Z, Grosmanova A, Pulkrabkova S, Gogela J: Effect of birth weight on neonatal and maternal morbidity in expectant management of post-term pregnancy. Ceska Gynekol. 2002, 67 (Suppl 1): 20-22.PubMed
42.
Sue AQAK, Hannah ME, Cohen MM, Foster GA, Liston RM: Effect of labour induction on rates of stillbirth and cesarean section in post-term pregnancies. CMAJ. 1999, 160 (8): 1145-1149.
43.
Votta RA, Cibils LA: Active management of prolonged pregnancy. Am J Obstet Gynecol. 1993, 168 (2): 557-563.CrossRefPubMed
44.
Zeitlin J, Blondel B, Alexander S, Breart G: Variation in rates of postterm birth in Europe: reality or artefact?. BJOG. 2007, 114 (9): 1097-1103. 10.1111/j.1471-0528.2007.01328.x.CrossRefPubMed
45.
Campbell MK, Ostbye T, Irgens LM: Post-term birth: risk factors and outcomes in a 10-year cohort of Norwegian births. Obstet Gynecol. 1997, 89 (4): 543-548. 10.1016/S0029-7844(97)00049-5.CrossRefPubMed
46.
Wennerholm UB, Hagberg H, Brorsson B, Bergh C: Induction of labor versus expectant management for post-date pregnancy: is there sufficient evidence for a change in clinical practice?. Acta Obstet Gynecol Scand. 2009, 88 (1): 6-17. 10.1080/00016340802555948.CrossRefPubMed
Metadata
Title
Elective induction for pregnancies at or beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with meta-analysis
Authors
Arwa Abbas Hussain
Mohammad Yawar Yakoob
Aamer Imdad
Zulfiqar A Bhutta
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue Special Issue 3/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-S3-S5

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