Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials

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dc.contributor.authorBernardes, T.
dc.contributor.authorBroekhuijsen, K.
dc.contributor.authorKoopmans, C.
dc.contributor.authorBoers, K.
dc.contributor.authorvan Wyk, L.
dc.contributor.authorTajik, P.
dc.contributor.authorvan Pampus, M.
dc.contributor.authorScherjon, S.
dc.contributor.authorMol, B.
dc.contributor.authorFranssen, M.
dc.contributor.authorvan den Berg, P.
dc.contributor.authorGroen, H.
dc.date.issued2016
dc.descriptionFirst published: 13 May 2016
dc.description.abstractObjectives: To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term. Design: Secondary analysis of data from two randomised clinical trials. Setting: Data were collected in two nationwide Dutch trials. Population: Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6. Methods: Comparison of outcomes after induction of labour and expectant management. Masin outcome measures: Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH <7.05 and/or neonatal intensive care unit admission and/or seizures and/or perinatal death. Results: Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference -1.1%, 95% CI -5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference -2.7%, 95% CI -7.6 to 2.2) or adverse neonatal outcome rates (difference -1.5%, 95% CI -4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference -3.2%, 95% CI -5.6 to -0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32. Conclusions: We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted.Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome.
dc.description.statementofresponsibilityT. P. Bernardes, K. Broekhuijsen, C. M. Koopmans, K. E. Boers, L. van Wyk, P. Tajik, M. G. van Pampus, S. A. Scherjon, B. W. Mol, M. T. Franssen, P. P. van den Berg, H. Groen
dc.identifier.citationBJOG: An International Journal of Obstetrics and Gynaecology, 2016; 123(9):1501-1508
dc.identifier.doi10.1111/1471-0528.14028
dc.identifier.issn1470-0328
dc.identifier.issn1471-0528
dc.identifier.orcidMol, B. [0000-0001-6887-0262] [0000-0001-8337-550X]
dc.identifier.urihttp://hdl.handle.net/2440/103312
dc.language.isoen
dc.publisherWiley
dc.rights© 2016 Royal College of Obstetricians and Gynaecologists
dc.source.urihttps://doi.org/10.1111/1471-0528.14028
dc.subjectCervical ripeness
dc.subjectexpectant management
dc.subjectfetal growth restriction
dc.subjecthypertensive disease
dc.subjectinduction of labour
dc.titleCaesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials
dc.typeJournal article
pubs.publication-statusPublished

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