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Induction of labor versus expectant management for post-date pregnancy: Is there sufficient evidence for a change in clinical practice?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2009 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 88, no 1, 6-17 p.Article, review/survey (Refereed) Published
Abstract [en]

Objectives. To compare perinatal and maternal outcomes between elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Design. Systematic review and meta-analysis. Methods. We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE) and PsycINFO (1980 to November, 2007). Inclusion criteria were systematic reviews and randomized controlled trials comparing elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Three or more reviewers independently read and evaluated all selected studies. Data were extracted and analyzed using Review Manager Software. Main outcome measures. Perinatal mortality. Results. Thirteen trials fulfilled the inclusion criteria for the meta-analysis. Elective induction of labor was not associated with lower risk of perinatal mortality compared to expectant management (relative risks (RR): 0.33; 95% confidence intervals (CI): 0.10-1.09). Elective induction was associated with a significantly lower rate of meconium aspiration syndrome (RR: 0.43; 95% CI: 0.23-0.79). More women randomized to expectant management were delivered by cesarean section (RR: 0.87; 95% CI: 0.80-0.96). Conclusions. The meta-analysis illustrated a problem with rare outcomes such as perinatal mortality. No individual study with adequate sample size has been published, nor would a meta-analysis based on the current literature be sufficient. The optimal management of pregnancies at 41 weeks and beyond is thus unknown.

Place, publisher, year, edition, pages
2009. Vol. 88, no 1, 6-17 p.
Keyword [en]
Post-term pregnancy, full-term pregnancy, induced labor, expectant management, perinatal death, meta-analyses
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-142366DOI: 10.1080/00016340802555948ISI: 000262419600002OAI: oai:DiVA.org:uu-142366DiVA: diva2:387476
Available from: 2011-01-14 Created: 2011-01-13 Last updated: 2017-12-11Bibliographically approved

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