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

Abstract

Objective 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.Main 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 À1.1%, 95% CI À5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference À2.7%, 95% CI À7.6 to 2.2) or adverse neonatal outcome rates (difference À1.5%, 95% CI À4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference À3.2%, 95% CI À5.6 to À0.9). 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.

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

“…Stock et al reported that elective induction of labor at term reduces perinatal mortality without increasing the risk of operative delivery [16]. This was confirmed in a more recent study in which induction of labor at low Bishop scores did not increase the risk of cesarean section or poor neonatal outcome [17].…”

Prognostic Factors of Successful Cervical Ripening and Labor Induction in Late-Onset Fetal Growth Restriction

“…There is still controversy regarding the relationship between labor induction requiring cervical ripening and whether there is an increased risk or not of cesarean section (CS) [8,9]. In the particular setting of FGR, it is important to take into account that expectant management until the spontaneous onset of labor may not be an option [10]. There is scarce evidence on which is the best approach for cervical ripening in this scenario.…”

Re: 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

“…I read with great interest the recently published study of Bernardes et al., from which the authors conclude that ‘induction of labour at low Bishop score does not increase caesarean section rate’ . In fact, Bernardes et al.…”