Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/103312
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Type: Journal article
Title: 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
Author: Bernardes, T.
Broekhuijsen, K.
Koopmans, C.
Boers, K.
van Wyk, L.
Tajik, P.
van Pampus, M.
Scherjon, S.
Mol, B.
Franssen, M.
van den Berg, P.
Groen, H.
Citation: BJOG: an International Journal of Obstetrics and Gynaecology, 2016; 123(9):1501-1508
Publisher: Wiley
Issue Date: 2016
ISSN: 1470-0328
1471-0528
Statement of
Responsibility: 
T. 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
Abstract: Objectives: 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.
Keywords: Cervical ripeness
expectant management
fetal growth restriction
hypertensive disease
induction of labour
Description: First published: 13 May 2016
Rights: © 2016 Royal College of Obstetricians and Gynaecologists
DOI: 10.1111/1471-0528.14028
Published version: http://dx.doi.org/10.1111/1471-0528.14028
Appears in Collections:Aurora harvest 7
Obstetrics and Gynaecology publications

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