Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study

Mette  Hedegaard; Ø Lidegaard; C W Skovlund; L S Mørch; Morten Hedegaard

doi:10.1111/1471-0528.13299

Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study

Mette Hedegaard, Ø Lidegaard, C W Skovlund, L S Mørch, Morten Hedegaard

31 Citations (Scopus)

Abstract

OBJECTIVE: To assess the changes in perinatal outcomes in children born from 37 weeks of gestation after implementation of a more proactive labour induction practice from 2009.

DESIGN: Register-based cohort study.

SETTING: Denmark, 2000-12.

POPULATION: Newborns from 37 weeks of gestation.

METHODS: Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index.

MAIN OUTCOME MEASURES: Perinatal outcomes.

RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH < 7.0 decreased by 23%; odds ratio (OR) 0.77 (95% confidence interval 0.67-0.89), and the adjusted OR of Apgar score < 7 at 5 minutes was unchanged. The risk of admission to neonatal intensive care units increased by 56%; OR 1.56 (1.47-1.66), whereas the risk of neonatal deaths decreased by 44%; OR 0.56 (0.45-0.70). The risk of cerebral palsy was from 2000-02 to 2009-10 reduced by 26%; OR 0.74 (0.60-0.90). The proportion of infants born with fetal weight ≥ 4500 g decreased by one-third; OR 0.68 (0.65-0.71). However, the risk of shoulder dystocia increased by 32%; OR 1.32 (1.21-1.44), whereas the risk of peripheral nerve injuries was reduced by 43%; OR 0.57 (0.45-0.73).

CONCLUSION: The results suggest an overall improvement in perinatal outcomes as a result of a more proactive post-term labour induction practice.

Original language	English
Journal	BJOG : an international journal of obstetrics and gynaecology
Volume	122
Issue number	10
Pages (from-to)	1377-85
Number of pages	9
ISSN	1470-0328
DOIs	https://doi.org/10.1111/1471-0528.13299
Publication status	Published - Sept 2015

Keywords

Adult
Birth Injuries
Cohort Studies
Denmark
Female
Gestational Age
Humans
Infant
Infant Mortality
Infant, Newborn
Infant, Newborn, Diseases
Infant, Postmature
Intensive Care, Neonatal
Labor, Induced
Logistic Models
Outcome Assessment (Health Care)
Pregnancy
Registries

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10.1111/1471-0528.13299

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@article{f7f29648c6754b59a162e1e8b5250e75,

title = "Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study",

abstract = "OBJECTIVE: To assess the changes in perinatal outcomes in children born from 37 weeks of gestation after implementation of a more proactive labour induction practice from 2009.DESIGN: Register-based cohort study.SETTING: Denmark, 2000-12.POPULATION: Newborns from 37 weeks of gestation.METHODS: Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index.MAIN OUTCOME MEASURES: Perinatal outcomes.RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased from 9.7\% in 2000-02 to 22.5\% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH < 7.0 decreased by 23\%; odds ratio (OR) 0.77 (95\% confidence interval 0.67-0.89), and the adjusted OR of Apgar score < 7 at 5 minutes was unchanged. The risk of admission to neonatal intensive care units increased by 56\%; OR 1.56 (1.47-1.66), whereas the risk of neonatal deaths decreased by 44\%; OR 0.56 (0.45-0.70). The risk of cerebral palsy was from 2000-02 to 2009-10 reduced by 26\%; OR 0.74 (0.60-0.90). The proportion of infants born with fetal weight ≥ 4500 g decreased by one-third; OR 0.68 (0.65-0.71). However, the risk of shoulder dystocia increased by 32\%; OR 1.32 (1.21-1.44), whereas the risk of peripheral nerve injuries was reduced by 43\%; OR 0.57 (0.45-0.73).CONCLUSION: The results suggest an overall improvement in perinatal outcomes as a result of a more proactive post-term labour induction practice.",

keywords = "Adult, Birth Injuries, Cohort Studies, Denmark, Female, Gestational Age, Humans, Infant, Infant Mortality, Infant, Newborn, Infant, Newborn, Diseases, Infant, Postmature, Intensive Care, Neonatal, Labor, Induced, Logistic Models, Outcome Assessment (Health Care), Pregnancy, Registries",

author = "Mette Hedegaard and {\O} Lidegaard and Skovlund, \{C W\} and M{\o}rch, \{L S\} and Morten Hedegaard",

note = "{\textcopyright} 2015 Royal College of Obstetricians and Gynaecologists.",

year = "2015",

month = sep,

doi = "10.1111/1471-0528.13299",

language = "English",

volume = "122",

pages = "1377--85",

journal = "BJOG : an international journal of obstetrics and gynaecology",

issn = "1470-0328",

publisher = "John Wiley and Sons Inc.",

number = "10",

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TY - JOUR

T1 - Perinatal outcomes following an earlier post-term labour induction policy

T2 - a historical cohort study

AU - Hedegaard, Mette

AU - Lidegaard, Ø

AU - Skovlund, C W

AU - Mørch, L S

AU - Hedegaard, Morten

PY - 2015/9

Y1 - 2015/9

N2 - OBJECTIVE: To assess the changes in perinatal outcomes in children born from 37 weeks of gestation after implementation of a more proactive labour induction practice from 2009.DESIGN: Register-based cohort study.SETTING: Denmark, 2000-12.POPULATION: Newborns from 37 weeks of gestation.METHODS: Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index.MAIN OUTCOME MEASURES: Perinatal outcomes.RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH < 7.0 decreased by 23%; odds ratio (OR) 0.77 (95% confidence interval 0.67-0.89), and the adjusted OR of Apgar score < 7 at 5 minutes was unchanged. The risk of admission to neonatal intensive care units increased by 56%; OR 1.56 (1.47-1.66), whereas the risk of neonatal deaths decreased by 44%; OR 0.56 (0.45-0.70). The risk of cerebral palsy was from 2000-02 to 2009-10 reduced by 26%; OR 0.74 (0.60-0.90). The proportion of infants born with fetal weight ≥ 4500 g decreased by one-third; OR 0.68 (0.65-0.71). However, the risk of shoulder dystocia increased by 32%; OR 1.32 (1.21-1.44), whereas the risk of peripheral nerve injuries was reduced by 43%; OR 0.57 (0.45-0.73).CONCLUSION: The results suggest an overall improvement in perinatal outcomes as a result of a more proactive post-term labour induction practice.

AB - OBJECTIVE: To assess the changes in perinatal outcomes in children born from 37 weeks of gestation after implementation of a more proactive labour induction practice from 2009.DESIGN: Register-based cohort study.SETTING: Denmark, 2000-12.POPULATION: Newborns from 37 weeks of gestation.METHODS: Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index.MAIN OUTCOME MEASURES: Perinatal outcomes.RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH < 7.0 decreased by 23%; odds ratio (OR) 0.77 (95% confidence interval 0.67-0.89), and the adjusted OR of Apgar score < 7 at 5 minutes was unchanged. The risk of admission to neonatal intensive care units increased by 56%; OR 1.56 (1.47-1.66), whereas the risk of neonatal deaths decreased by 44%; OR 0.56 (0.45-0.70). The risk of cerebral palsy was from 2000-02 to 2009-10 reduced by 26%; OR 0.74 (0.60-0.90). The proportion of infants born with fetal weight ≥ 4500 g decreased by one-third; OR 0.68 (0.65-0.71). However, the risk of shoulder dystocia increased by 32%; OR 1.32 (1.21-1.44), whereas the risk of peripheral nerve injuries was reduced by 43%; OR 0.57 (0.45-0.73).CONCLUSION: The results suggest an overall improvement in perinatal outcomes as a result of a more proactive post-term labour induction practice.

KW - Adult

KW - Birth Injuries

KW - Cohort Studies

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KW - Female

KW - Gestational Age

KW - Humans

KW - Infant

KW - Infant Mortality

KW - Infant, Newborn

KW - Infant, Newborn, Diseases

KW - Infant, Postmature

KW - Intensive Care, Neonatal

KW - Labor, Induced

KW - Logistic Models

KW - Outcome Assessment (Health Care)

KW - Pregnancy

KW - Registries

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U2 - 10.1111/1471-0528.13299

DO - 10.1111/1471-0528.13299

M3 - Journal article

C2 - 25690911

SN - 1470-0328

VL - 122

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EP - 1385

JO - BJOG : an international journal of obstetrics and gynaecology

JF - BJOG : an international journal of obstetrics and gynaecology

IS - 10

ER -

Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study

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