Download PDF
Geburtshilfe Frauenheilkd 2016; 76(07): 793-798
DOI: 10.1055/s-0042-107672
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Induction of Labour in Late and Postterm Pregnancies and its Impact on Maternal and Neonatal Outcome

Die Geburtseinleitung bei übertragener Schwangerschaft und die Auswirkungen auf mütterliches und kindliches Outcome
F. Thangarajah   *
University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
,
P. Scheufen   *
University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
,
V. Kirn
University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
,
P. Mallmann
University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany
› Author Affiliations
Further Information

Publication History

received 28 February 2016
revised 11 April 2016

accepted 28 April 2016

Publication Date:
20 July 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Introduction: This study aimed to determine the effects of induction of labour in late-term pregnancies on the mode of delivery, maternal and neonatal outcome. Methods: We retrospectively analyzed deliveries between 2000 and 2014 at the University Hospital of Cologne. Women with a pregnancy aged between 41 + 0 to 42 + 6 weeks were included. Those who underwent induction of labour were compared with women who were expectantly managed. Maternal and neonatal outcomes were evaluated. Results: 856 patients were included into the study. The rate of cesarean deliveries was significantly higher for the induction of labour group (33.8 vs. 21.1 %, p < 0.001). Aside from the more frequent occurrence of perineal lacerations (induction of labour group vs. expectantly managed group = 38.1 % compared with 26.4 %, p = 0.002) and all types of lacerations (induction of labour group vs. expectantly managed group = 61.5% vs. 52.2 %, p = 0.021) in women with vaginal delivery, there were no significant differences in maternal outcome. Besides, no differences regarding neonatal outcome were observed. Conclusions: Our study suggests that induction of labour in late and postterm pregnancies is associated with a significantly higher cesarean section rate. Other maternal and fetal parameters were not influenced by induction of labour.

Zusammenfassung

Einleitung: Diese Studie untersuchte die Auswirkungen der Geburtseinleitung in der Spätschwangerschaft bzw. bei Übertragung auf die Art der Entbindung sowie auf das mütterliche und kindliche Outcome. Methoden: Alle in der Universitätsklinik Köln zwischen 2000 und 2014 erfolgten Entbindungen wurden retrospektiv untersucht. Alle Frauen, die in der 41 + 0 bis 42 + 6 Schwangerschaftswoche entbanden, wurden in die Studie eingeschlossen. Schwangere Frauen, bei denen eine Geburtseinleitung durchgeführt wurde, wurden mit Frauen verglichen, die exspektativ behandelt wurden. Die mütterlichen und kindlichen Outcomes wurden ausgewertet. Ergebnisse: Es wurden insgesamt 856 Patientinnen in die Studie aufgenommen. Die Kaiserschnittrate war in der Geburtseinleitungs-Gruppe signifikant höher (33.8 vs. 21.1 %, p < 0.001). Abgesehen von einem häufigeren Auftreten von Dammrissen (Geburtseinleitungs-Gruppe vs. Gruppe mit exspektativem Vorgehen = 38,1 vs. 26,4 %; p = 0,002) sowie aller Arten von Risswunden (Geburtseinleitungs-Gruppe vs. Gruppe mit exspektativem Vorgehen = 61,5 vs. 52,2 %; p = 0,021) bei Frauen, die vaginal entbanden, gab es keine wesentlichen Unterschiede im mütterlichen Outcome. Es gab auch keine signifikanten Unterschiede im Neugeborenen-Outcome zwischen den beiden Gruppen. Schlussfolgerung: Unsere Studie zeigte, dass die Geburtseinleitung bei Terminüberschreitung und Übertragung mit einer signifikant höheren Sectio-Rate verbunden ist. Die Geburtseinleitung führte zu keiner Änderung hinsichtlich anderer mütterlichen und fetalen Faktoren.

Key words

induction of labour - delivery - cesarean section - materno-fetal medicine

Schlüsselwörter

Geburtseinleitung - Entbindung - Kaiserschnittentbindung - Perinatalmedizin

*

* Equally contributing authors


 

  • References

  • 1 ACOG. ACOG practice patterns. Management of postterm pregnancy. Number 6, October 1997. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1998; 60: 86-91
    CrossrefPubMedGoogle Scholar
  • 2 Norwitz ER, Snegovskikh VV, Caughey AB. Prolonged pregnancy: when should we intervene?. Clin Obstet Gynecol 2007; 50: 547-557
    CrossrefPubMedGoogle Scholar
  • 3 Laursen M, Bille C, Olesen AW et al. Genetic influence on prolonged gestation: a population-based Danish twin study. Am J Obstet Gynecol 2004; 190: 489-494
    CrossrefPubMedGoogle Scholar
  • 4 Stotland NE, Washington AE, Caughey AB. Prepregnancy body mass index and the length of gestation at term. Am J Obstet Gynecol 2007; 197: 378.e1-378.e5
    CrossrefPubMedGoogle Scholar
  • 5 ACOG. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1) 386-397
    CrossrefPubMedGoogle Scholar
  • 6 National Institute for Health and Clinical Excellence. Induction of Labour, NICE Clinical guideline 70. Online: http://www.nice.org.uk/guidance/cg70/resources/guidance-induction-of-labour-pdf last access: 01.10.2014
    PubMedGoogle Scholar
  • 7 Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. Leitlinie Vorgehen bei Terminüberschreitung und Übertragung [updated 2014 Oct 22]. Online: http://www.awmf.org/uploads/tx_szleitlinien/015-065l_S1_Termin%25C3%25BCberschreitung_%25C3%259Cbertragung_02-2014.pdf last access: 22.10.2014
    PubMedGoogle Scholar
  • 8 Daskalakis G, Zacharakis D, Simou M et al. Induction of labor versus expectant management for pregnancies beyond 41 weeks. J Matern Fetal Neonatal Med 2014; 27: 173-176
    CrossrefPubMedGoogle Scholar
  • 9 Hutcheon J, Harper S, Strumpf E et al. Using inter-institutional practice variation to understand the risks and benefits of routine labour induction at 41(+0) weeks. BJOG 2015; 122: 973-981
    CrossrefPubMedGoogle Scholar
  • 10 Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG 2014; 121: 674-685 discussion 685
    CrossrefPubMedGoogle Scholar
  • 11 Wolfe H, Timofeev J, Tefera E et al. Risk of cesarean in obese nulliparous women with unfavorable cervix: elective induction vs. expectant management at term. Am J Obstet Gynecol 2014; 211: 53.e1-53.e5
    Google Scholar
  • 12 Vrouenraets FP, Roumen FJ, Dehing CJ et al. Bishop score and risk of cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 2005; 105: 690-697
    CrossrefPubMedGoogle Scholar
  • 13 Caughey AB, Sundaram V, Kaimal AJ et al. Systematic review: elective induction of labor versus expectant management of pregnancy. Ann Intern Med 2009; 151: 252-263 W53–W63
    CrossrefPubMedGoogle Scholar
  • 14 Chanrachakul B, Herabutya Y. Postterm with favorable cervix: is induction necessary?. Eur J Obstet Gynecol Reprod Biol 2003; 106: 154-157
    CrossrefPubMedGoogle Scholar
  • 15 Osmundson S, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with an unfavorable cervix. Obstet Gynecol 2011; 117: 583-587
    CrossrefPubMedGoogle Scholar
  • 16 Wang M, Fontaine P. Common questions about late-term and postterm pregnancy. Am Fam Physician 2014; 90: 160-165
    PubMedGoogle Scholar
  • 17 Alexander JM, McIntire DD, Leveno KJ. Forty weeks and beyond: pregnancy outcomes by week of gestation. Obstet Gynecol 2000; 96: 291-294
    CrossrefPubMedGoogle Scholar
  • 18 Caughey AB, Stotland NE, Washington AE et al. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol 2007; 196: 155.e1-155.e6
    CrossrefPubMedGoogle Scholar
  • 19 Cheng YW, Nicholson JM, Nakagawa S et al. Perinatal outcomes in low-risk term pregnancies: do they differ by week of gestation?. Am J Obstet Gynecol 2008; 199: 370.e1-370.e7
    CrossrefPubMedGoogle Scholar
  • 20 Bruckner TA, Cheng YW, Caughey AB. Increased neonatal mortality among normal-weight births beyond 41 weeks of gestation in California. Am J Obstet Gynecol 2008; 199: 421.e1-421.e7
    CrossrefPubMedGoogle Scholar
  • 21 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: 222-227
    CrossrefPubMedGoogle Scholar
  • 22 Nakling J, Backe B. Pregnancy risk increases from 41 weeks of gestation. Acta Obstet Gynecol Scand 2006; 85: 663-668
    CrossrefPubMedGoogle Scholar
  • 23 Hilder L, Sairam S, Thilaganathan B. Influence of parity on fetal mortality in prolonged pregnancy. Eur J Obstet Gynecol Reprod Biol 2007; 132: 167-170
    CrossrefPubMedGoogle Scholar
  • 24 Ingemarsson I, Källén K. Stillbirths and rate of neonatal deaths in 76,761 postterm pregnancies in Sweden, 1982–1991: a register study. Acta Obstet Gynecol Scand 1997; 76: 658-662
    CrossrefPubMedGoogle Scholar
  • 25 Hannah ME, Hannah WJ, Hellmann J et al. 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: 1587-1592
    CrossrefPubMedGoogle Scholar
  • 26 Hermus MA, Verhoeven CJ, Mol BW et al. Comparison of induction of labour and expectant management in postterm pregnancy: a matched cohort study. J Midwifery Womens Health 2009; 54: 351-356
    CrossrefPubMedGoogle Scholar
  • 27 Hernández-Martínez A, Pascual-Pedreño AI, Baño-Garnés AB et al. Relation between induced labour indications and neonatal morbidity. Arch Gynecol Obstet 2014; 290: 1093-1099
    CrossrefPubMedGoogle Scholar
  • 28 Prysak M. Elective induction versus spontaneous labor: a case-control analysis of safety and efficacy. Obstet Gynecol 1998; 92: 47-52
    CrossrefPubMedGoogle Scholar
  • 29 van Gemund N, Hardeman A, Scherjon SA et al. Intervention rates after elective induction of labor compared to labor with a spontaneous onset. Gynecol Obstet Invest 2003; 56: 133-138
    CrossrefPubMedGoogle Scholar
  • 30 Katz Z, Yemini M, Lancet M et al. Non-aggressive management of post-date pregnancies. Eur J Obstet Gynecol Reprod Biol 1983; 15: 71-79
    CrossrefPubMedGoogle Scholar
  • 31 Boulvain M, Marcoux S, Bureau M et al. Risks of induction of labour in uncomplicated term pregnancies. Paediatr Perinat Epidemiol 2001; 15: 131-138
    CrossrefPubMedGoogle Scholar
  • 32 Roach VJ, Rogers MS. Pregnancy outcome beyond 41 weeks gestation. Int J Gynecol Obstet 1997; 59: 19-24
    CrossrefPubMedGoogle Scholar
  • 33 Stock SJ, Ferguson E, Duffy A et al. Outcomes of elective induction of labour compared with expectant management: population based study. BMJ 2012; 344: e2838
    CrossrefPubMedGoogle Scholar
  • 34 Witter FR, Weitz CM. A randomized trial of induction at 42 weeks gestation versus expectant management for postdates pregnancies. Am J Perinatol 1987; 4: 206-211
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Nielsen PE, Howard BC, Hill CC et al. Comparison of elective induction of labor with favorable Bishop scores versus expectant management: a randomized clinical trial. J Matern Fetal Neonatal Med 2005; 18: 59-64
    CrossrefPubMedGoogle Scholar
  • 36 Heimstad R, Skogvoll E, Mattsson L et al. Induction of labor or serial antenatal fetal monitoring in postterm pregnancy: a randomized controlled trial. Obstet Gynecol 2007; 109: 609-617
    CrossrefPubMedGoogle Scholar
  • 37 Parry E, Parry D, Pattison N. Induction of labour for post term pregnancy: an observational study. Aust N Z J Obstet Gynaecol 1998; 38: 275-280
    CrossrefPubMedGoogle Scholar
  • 38 James C, George SS, Gaunekar N et al. Management of prolonged pregnancy: a randomized trial of induction of labour and antepartum foetal monitoring. Natl Med J India 2001; 14: 270-273
    PubMedGoogle Scholar
  • 39 Crane JM. Factors predicting labor induction success: a critical analysis. Clin Obstet Gynecol 2006; 49: 573-584
    CrossrefPubMedGoogle Scholar
  • 40 Heffner L. Impact of labor induction, gestational age, and maternal age on cesarean delivery rates. Obstet Gynecol 2003; 102: 287-293
    CrossrefPubMedGoogle Scholar
  • 41 Bodner-Adler B, Bodner K, Pateisky N et al. Influence of labor induction on obstetric outcomes in patients with prolonged pregnancy. Wien Klin Wochenschr 2005; 117: 287-292
    CrossrefPubMedGoogle Scholar
  • 42 Wennerholm U, Hagberg H, Brorsson B et al. 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: 6-17
    CrossrefPubMedGoogle Scholar
  • 43 Gülmezoglu AM, Crowther CA, Middleton P et al. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012; (6) CD004945
    PubMedGoogle Scholar
  • 44 Khireddine I, Le Ray C, Dupont C et al. Induction of labor and risk of postpartum hemorrhage in low risk parturients. PloS one 2013; 8: e54858
    CrossrefPubMedGoogle Scholar
  • 45 Mandruzzato G, Alfirevic Z, Chervenak F et al. Guidelines for the management of postterm pregnancy. J Perinat Med 2010; 38: 111-119
    PubMedGoogle Scholar