Intrapartum intervention rates and perinatal outcomes following induction of labour compared to expectant management at term from an Australian perinatal centre

Zhao, Yi; Flatley, Christopher; Kumar, Sailesh

doi:10.1111/ajo.12576

Cited by 18 publications

(22 citation statements)

References 22 publications

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“…It is possible that the missing data is a reflection of unclear documentation in the woman’s pregnancy records of the reason why she was booked for IOL by the physician when the procedure was decided or the possibility that women with missing indication could have been induced for a reason that is not in line with the local evidence-based policy. Although lack of documented reason for induction has been demonstrated in several studies, the rate we report is higher than those reported from South America (44%),30 Australia (16.1%),31 and the United States (7.9%) 9. However, it is important to note that some of these studies categorized women with no documented reason for induction as elective (no medical indication) inductions 8,9,30.…”

Section: Strengths and Limitationscontrasting

confidence: 71%

<p>Induction Of Labor Among Singleton Pregnancies In Six Palestinian Governmental Hospitals: A Population-Based Cohort Study</p>

Hassan

Laine

Fosse

et al. 2019

IJWH

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ObjectiveTo explore rates and review practices regarding induction of labor (IOL) among singleton pregnancies in Palestine.DesignA prospective population-based cohort study.SettingSix secondary and tertiary governmental hospitals located in the two regions of Palestine: West Bank and Gaza.ParticipantsSingleton pregnancies who had IOL in participating units during the study period were included (n=8290). Women having multiple gestations (1004), planned cesarean births (703), those admitted with cervical dilation >6cm (11228), and pregnancies with no record of cervical dilation and/or gestational age on admission (219) were excluded.Primary outcome measureRates of IOL in participating units and regions.ResultsThere were a total of 33,402 singleton births during the study period with an IOL rate of 24.8%. Rates of IOL significantly varied between units, ranging from 12.9% to 45.6% (P-value <0.05). The majority of women with no previous uterine scar were induced at gestational ages ≤40 weeks where 43.8% were induced at 39–40 gestational weeks (29.9% multiparous; 13.9% nulliparous) and 17.7% were induced between 37 and 38 gestational weeks (11.9% multiparous; 5.8% nulliparous).ConclusionSignificant variations in IOL practices between Palestinian hospitals and regions suggest overuse of IOL among singleton pregnancies in some units with the majority of these being performed before 40 weeks’ gestation. These findings indicate a gap between implementation of best evidence and current clinical practice.

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Section: Strengths and Limitationscontrasting

confidence: 71%

<p>Induction Of Labor Among Singleton Pregnancies In Six Palestinian Governmental Hospitals: A Population-Based Cohort Study</p>

Hassan

Laine

Fosse

et al. 2019

IJWH

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“…Observational studies comparing IOL with expectant management from outside the USA are scant. In a single‐center retrospective cohort study from Australia, IOL was associated with increased risk of emergency cesarean for intrapartum fetal distress 19 . A Danish birth registry‐based study indicated increased risk of cesarean delivery following IOL at 37 and 38 weeks, whereas there was no significant difference from gestation week 39 and after in either nulliparous or parous women 20 .…”

Section: Discussionmentioning

confidence: 99%

Cesarean delivery after non‐medically indicated induction of labor: A population‐based study using different definitions of expectant management

Zenzmaier

Pfeifer

Leitner

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Most observational studies found that non‐medically indicated induction of labor (IOL) is not associated with an increased risk of cesarean delivery compared with expectant management, defined as all births at a later gestation. However, given the higher rate of cesarean delivery at late term, this definition of the expectant management group might bias the results of observational studies in favor of IOL at early or full term when estimating the risk of short‐term (eg up to 1 week) expectant management. Material and methods We conducted a retrospective cohort study including 447 066 singleton term and post‐term hospital births that occurred in Austria between 2008 and 2016. Multivariate logistic regression was used to test the association of IOL and cesarean delivery at each week of gestation from 37‐41. Expectant management was either defined as all births at “next week or beyond” or “at next week”. Results Non‐medically indicated IOL was associated with increased odds for cesarean delivery at 37 and 38 weeks, and reduced odds at 40 and 41 weeks. At 39 weeks, IOL resulted in comparable cesarean rates compared with expectant management defined as “next week or beyond” (17.2% vs 16.2%; adjusted odds ratio [OR] 0.93; 95% confidence interval [CI] 0.86‐1.00; P = .059). However, when defined as births “at the next week”, expectant management was associated with significantly reduced odds for cesarean delivery (13.6%; adjusted OR 0.76; 95% CI 0.70‐0.82; P < .001). Comparison of the cesarean delivery rates for the two definitions of expectant management showed that the “next week and beyond” model underestimates the benefit of short‐term expectant management by up to 1 week, particularly for IOL at weeks 38 and 39. Conclusions Our findings demonstrate that the definition of the expectant management group has a significant impact when analyzing the outcome of IOL in retrospective cohort studies. Non‐medically indicated IOL is not an all‐or‐none choice between “elective” induction and indefinite expectant management. Thus, to define the control group as all births at the next week could be useful for clinical decision‐making, as it allows to estimate the risks of expectant management until the next appointment compared with immediate IOL.

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“…We also did not include differences of induction of labour rates between the two cohorts and this might have potentially influenced the outcomes. The influence of induction of labour on caesarean section rates and neonatal outcomes are however conflicting, with some studies [ 32 ] demonstrating no difference in either operative birth rates and others[ 33 ] suggesting an increase in intervention in the induction cohort. Other possible residual confounders including maternal educational level, number of antenatal visits, model of antenatal care, alcohol intake, or other barriers that may have influenced a woman’s experience in accessing care, were not measured.…”

Section: Discussionmentioning

confidence: 99%

Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term – A retrospective cohort study

et al. 2017

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BackgroundPerinatal outcomes may be influenced by a variety of factors including maternal demographics and medical condition as well as socio-economic status. The evidence for disparities in health outcomes stratified by type of care (public or private) is lacking. The aim of this study was to investigate short term neonatal outcomes following category 1 and 2 emergency cesareans at term between publicly and privately funded women at a single major tertiary centre in Australia. Category 1—immediate threat to life (maternal or fetal); Category 2—maternal or fetal compromise that is not immediately life-threatening.MethodsThis was a retrospective, cross sectional study of 61355 term singleton babies born at the Mater Mother’s Hospital in Brisbane, Australia in 2007–2014. We collected data from the hospital’s maternity database and compared maternal demographics, indications for cesarean and neonatal outcomes for publicly and privately funded women.ResultsOver the study period there were 32477 public and 28878 private, term singleton births. Compared to the publicly funded cohort, privately insured women were older, had lower BMI, were of Caucasian ethnicity, Australian born, nulliparous, had shorter labors and had lower rates of hypertensive disorders and diabetes. The most common indications for category 1 and category 2 cesareans in combination were non-reassuring fetal status followed by failure to progress in labor and malpresentation. For both category 1 and 2 cesareans, neonatal outcomes (Apgar score <7 at 5 minutes, abnormal cord gases, Neonatal Critical Care Unit admission rates, rates of severe respiratory distress and jaundice) were significantly worse in the publicly funded compared to the privately insured cohort Multivariate analyses controlling for maternal age, ethnicity, country of birth, parity, hypertension, diabetes mellitus, gestational age at birth and length of labour confirmed that private insurance status was highly protective for the perinatal outcomes of Apgar score <7 at 5 minutes (aOR 0.26, 95% CI 0.13–0.55), admission to NCCU (OR 0.51, 95% CI 0.30–0.92) and respiratory distress (aOR 0.60, 95% CI 0.41–0.86).ConclusionBirth in the private health sector was inversely associated with adverse neonatal outcomes following category 1 and 2 cesareans.

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Intrapartum intervention rates and perinatal outcomes following induction of labour compared to expectant management at term from an Australian perinatal centre

Cited by 18 publications

References 22 publications

<p>Induction Of Labor Among Singleton Pregnancies In Six Palestinian Governmental Hospitals: A Population-Based Cohort Study</p>

<p>Induction Of Labor Among Singleton Pregnancies In Six Palestinian Governmental Hospitals: A Population-Based Cohort Study</p>

Cesarean delivery after non‐medically indicated induction of labor: A population‐based study using different definitions of expectant management

Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term – A retrospective cohort study

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