Has perinatal outcome improved after introduction of a guideline in favour of routine induction and increased surveillance prior to 42 weeks of gestation?

Wolff, Sanne Lausen; Lorentzen, Iben Prentow; Kaltoft, Agnete Pers; Schmidt, H; Jeppesen, Monique Mensink; Maimburg, Rikke Damkjær

doi:10.1016/j.srhc.2016.03.002

Cited by 12 publications

(10 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our study, we included inductions of both high‐ and low‐risk pregnancies and it would therefore be reasonable to expect a higher rate of cesarean section deliveries in our study, even though this was not the case. As in our study, the Danish cross‐sectional population‐based register study demonstrated a decreased risk of cesarean section, even though this was only the case in nulliparous, uncomplicated pregnancies …”

Section: Discussionsupporting

confidence: 69%

See 1 more Smart Citation

Induction of labor with high‐ or low‐dosage oral misoprostol—A Danish descriptive retrospective cohort study 2015‐16

Bendix

Petersen

Andersen

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction:In Denmark, the rate of induced labor from 37 gestational weeks has increased by 108% from 12.4% in 2000 to 25.1% in 2012, and today more than 1 in 4 deliveries are induced. Standard procedure at North Zealand Hospital changed in 2016 from a dosage of 50 µg oral misoprostol 2-3 times daily, to 25 µg up to 8 times daily. Also, since 2016 healthy women with uncomplicated pregnancies (primiparous and multiparous) have been offered induction as an outpatient procedure. This study aimed to compare the current low-dosage procedure (25 µg) with the former highdosage procedure (50 µg) in terms of induction to delivery time, maternal and fetal outcomes, and risk of uterine hyperstimulation. Material and methods:Data from June 2015 to October 2016 were included.Comparable baseline, demographic, and obstetric data for women induced according to high-dosage or low-dosage protocols were retrieved from local medical files.Descriptive statistics, Pearson's chi-squared tests, Kaplan-Meier survival estimates, and logistic regression analyses were performed. Results:The study included 816 induced deliveries. The high-and low-dosage groups differed in rates of plurality and place of induction. Induction to delivery times lasting longer than 72 hours were significantly decreased in the low-dosage group (adjusted odds ratio [aOR] 0.48, 95% confidence interval [95% CI] 0.27 to 0.86). Women in the low-dosage group also less often needed additional induction (P = 0.02), and the rate of uterine hyperstimulation was low irrespective of protocol (1% vs 3%, P = 0.16).There were no cases of uterine rupture in either group. The probability of vaginal delivery in the low-dosage group increased (adjusted hazard ratio 1.27, 95% CI 1.08 to 1.49), as did the risk of delivery with vacuum extraction (aOR 2.27, 95% CI 1.24 to 4.15), whereas delivery by cesarean section slightly decreased (aOR 0.89, 95% CI 0.59 to 1.33). The risk of meconium-stained liquor was nonsignificantly decreased (aOR 0.82, 95% CI 0.55 to 1.23). Conclusions: The low-dosage induction protocol was associated with favorable obstetric outcomes in terms of increased probability of vaginal delivery, but with higher risk of vacuum extraction. Protracted inductions and additional nonmedical interventions were reduced. There were no cases of uterine rupture. Statistically | 223 BENDIX Et al. How to cite this article: Bendix JM, Friis Petersen J, Andersen BR, Bødker B, Løkkegaard EC. Induction of labor with high-or low-dosage oral misoprostol-A Danish descriptive retrospective cohort study 2015-16. Acta Obstet Gynecol Scand. 2020;99:222-230. https ://doi.

show abstract

Section: Discussionsupporting

confidence: 69%

“…Following the changes in 2011 intensifying late‐pregnancy surveillance and implementing earlier induction of labor before week 42, a Danish cross‐sectional population‐based register study examined perinatal outcomes. The study reported a rate of vacuum extractions similar to the low‐dosage group in our study.…”

Section: Discussionmentioning

confidence: 99%

Induction of labor with high‐ or low‐dosage oral misoprostol—A Danish descriptive retrospective cohort study 2015‐16

Bendix

Petersen

Andersen

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…The exposure of interest was the new protocol from March 2011 and implemented during 2011 at Danish hospitals offering routine induction at 41+3–41+5 GW 10…”

Section: Methodsmentioning

confidence: 99%

“…Changing the protocol to offer routine induction between 41+3 and 41+5 GW thus changes the number of ongoing pregnancies and could lead to an additional 13%–15% of women being encouraged to have an induction,4 with possible iatrogenic consequences 9. One year after the Danish shift in the protocol, the new induction paradigm was almost fully implemented 10. In the following year, two Danish studies evaluated the consequences and found a considerable reduction in stillbirths 11 12.…”

Section: Introductionmentioning

confidence: 99%

Routine induction in late-term pregnancies: follow-up of a Danish induction of labour paradigm

et al. 2019

Self Cite

View full text Add to dashboard Cite

ObjectivesFor many years, routine elective induction of labour at gestational week (GW) 42+0 has been recommended in Denmark. In 2011, a more proactive protocol was introduced aimed at reducing stillbirths, and practice changed into earlier routine induction, i.e. between 41+3 and 41+5 GW. The present study evaluates a national change in induction of labour regime. The trend of maternal and neonatal consequences are monitored in the preintervention period (2000–2010) compared with the postintervention period (2012–2016).DesignA national retrospective register-based cohort study.SettingDenmark.ParticipantsAll births in Denmark 41+3 to 45+0 GWs between 2000 and 2016 (N = 152 887).Outcome measuresPrimary outcomes: stillbirths, perinatal death, and low Apgar scores. Additional outcomes: birth interventions and maternal outcomes.ResultsFor the primary outcomes, no differences in stillbirths, perinatal death, and low Apgar scores were found comparing the preintervention and postintervention period. Of additional outcomes, the trend changed significantly postintervention concerning use of augmentation of labour, epidural analgesia, induction of labour and uterine rupture (all p<0.05). There was no significant change in the trend for caesarean section and instrumental birth. Most notable for clinical practice was the increase in induction of labour from 41% to 65% (p<0.01) at 41+3 weeks during 2011 as well as the rare occurrence of uterine ruptures (from 2.6 to 4.2 per thousand, p<0.02).ConclusionsEvaluation of a more proactive regimen recommending induction of labour from GW 41+3 compared with 42+0 using national register data found no differences in neonatal outcomes including stillbirth. The number of women with induced labour increased significantly.

show abstract

“…Several studies have evaluated the policy of birth induction versus expectant management regarding perinatal outcomes, frequency of caesarean section, instrumental birth rate, etc. [7][8][9][10][11][12]. However, there is a lack of studies that investigated the operational impact on post-term pregnancy outpatient clinics after the change of guidelines.…”

Section: Contextmentioning

confidence: 99%

Capacity and patient flow planning in post-term pregnancy outpatient clinics: a computer simulation modelling study

Viana

Simonsen

Faraas

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: The demand for a large Norwegian hospital's post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital's catchment area and to clinical guidelines. Planning the clinic is further complicated due to the high did not attend rates as a result of women giving birth. The aim of this study is to determine the maximum number of women specified clinic configurations, combination of specified clinic resources, can feasibly serve within clinic opening times. Methods: A hybrid agent based discrete event simulation model of the clinic was used to evaluate alternative configurations to gain insight into clinic planning and to support decision making. Clinic configurations consisted of six factors: X0: Arrivals. X1: Arrival pattern. X2: Order of midwife and doctor consultations. X3: Number of midwives. X4: Number of doctors. X5: Number of cardiotocography (CTGs) machines. A full factorial experimental design of the six factors generated 608 configurations. Results: Each configuration was evaluated using the following measures: Y1: Arrivals. Y2: Time last woman checks out. Y3: Women's length of stay (LoS). Y4: Clinic overrun time. Y5: Midwife waiting time (WT). Y6: Doctor WT. Y7: CTG connection WT. Optimisation was used to maximise X0 with respect to the 32 combinations of X1-X5. Configuration 0a, the base case Y1 = 7 women and Y3 = 102.97 [0.21] mins. Changing the arrival pattern (X1) and the order of the midwife and doctor consultations (X2) configuration 0d, where X3, X4, X5 = 0a, Y1 = 8 woman and Y3 86.06 [0.10] mins. Conclusions: The simulation model identified the availability of CTG machines as a bottleneck in the clinic, indicated by the WT for CTG connection effect on LoS. One additional CTG machine improved clinic performance to the same degree as an extra midwife and an extra doctor. The simulation model demonstrated significant reductions to LoS can be achieved without additional resources, by changing the clinic pathway and scheduling of appointments. A more general finding is that a simulation model can be used to identify bottlenecks, and efficient ways of restructuring an outpatient clinic.

show abstract

Has perinatal outcome improved after introduction of a guideline in favour of routine induction and increased surveillance prior to 42 weeks of gestation?

Cited by 12 publications

References 13 publications

Induction of labor with high‐ or low‐dosage oral misoprostol—A Danish descriptive retrospective cohort study 2015‐16

Induction of labor with high‐ or low‐dosage oral misoprostol—A Danish descriptive retrospective cohort study 2015‐16

Routine induction in late-term pregnancies: follow-up of a Danish induction of labour paradigm

Capacity and patient flow planning in post-term pregnancy outpatient clinics: a computer simulation modelling study

Contact Info

Product

Resources

About