Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37–42 in Norway during 1999–2019

Haavaldsen, Camilla; Morken, Nils‐Halvdan; Saugstad, Ola Didrik; Eskild, Anne

doi:10.1111/aogs.14489

Cited by 12 publications

(3 citation statements)

References 30 publications

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“…An increase in post-term labour inductions in Norway since 1999 has resulted in fewer severe post-term pregnancies as well as a reduction in total post-term birth proportions. 31 Consequently, the reported post-term male predominance was less pronounced in our study compared to previous reports. 10,13 As the risk of adverse outcomes increases with gestational age in the post-term period, 32 it is plausible that a policy of earlier induction of labour will attenuate the risk of sex-specific adverse outcomes from ultrasound estimation of gestational age.…”

Section: Mean (Sd) Mean (Sd)contrasting

confidence: 80%

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Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population‐based cohort study

Einum,

Sørbye,

Nilsen

et al. 2023

Paediatric Perinatal Epid

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BackgroundGestational age estimation by second‐trimester ultrasound biometry introduces systematic errors due to sex differences in early foetal growth, consequently increasing the risk of adverse neonatal outcomes. Ultrasound estimation earlier in pregnancy may reduce this bias.ObjectivesTo investigate the distribution of sex ratio by gestational age and estimate the risk of adverse outcomes in male foetuses born early‐term and female foetuses born post‐term by first‐ and second‐trimester ultrasound estimations.MethodsThis population‐based study compared two cohorts of births with gestational age based on first‐ and second‐trimester ultrasound in the Medical Birth Registry of Norway between 2016 and 2020. We used a log‐binomial regression model to estimate adjusted relative risk (RR) with 95% confidence interval (CI) for Apgar score <7 at 5 min, umbilical artery pH <7.05, neonatal intensive care unit (NICU) admission and respiratory morbidity in relation to foetal sex.ResultsThe sex ratio at birth in gestational weeks 36–43 showed less male predominance in pregnancies estimated in first compared to second trimester. Any adverse outcome was registered in 627 of 4470 male infants born in gestational weeks 37–38 and 618 of 6406 females born ≥41 weeks. Male infants born in weeks 37–38 had lower risk of NICU admission (RR 0.76, 95% CI 0.58, 0.99), Apgar score <7 at 5 min (RR 0.63, 95% CI 0.28, 1.41) and respiratory morbidity (RR 0.68, 95% CI 0.37, 1.25) in first‐ compared to second‐trimester estimations. Female infants estimated in first trimester born ≥41 weeks had lower risk of umbilical artery pH <7.05, NICU admissions and respiratory morbidity; however, CIs were wide.ConclusionsEarly ultrasound estimation of gestational age may reduce the excess risk of adverse neonatal outcomes and highlight the role of foetal sex and the timing of ultrasound assessment in the clinical evaluation of preterm and post‐term pregnancies.

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Section: Mean (Sd) Mean (Sd)contrasting

confidence: 80%

“…An increase in post‐term labour inductions in Norway since 1999 has resulted in fewer severe post‐term pregnancies as well as a reduction in total post‐term birth proportions 31 . Consequently, the reported post‐term male predominance was less pronounced in our study compared to previous reports 10,13 .…”

Section: Discussioncontrasting

confidence: 59%

Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population‐based cohort study

Einum,

Sørbye,

Nilsen

et al. 2023

Paediatric Perinatal Epid

Self Cite

View full text Add to dashboard Cite

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“…However, in nulliparous women, induction of labour was associated with shoulder dystocia [ 20 ]. The external validity of these studies [ 19 , 20 ] for the Norwegian practice is questionable since intervention rates during spontaneous and induced labour are substantially lower [ 21 , 22 ]. There is some evidence that induction of labour may reduce perinatal death and morbidity [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Placental pathology and neonatal morbidity: exploring the impact of gestational age at birth

Budal,

Kessler,

Eide

et al. 2024

BMC Pregnancy Childbirth

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Aim To evaluate placental pathology in term and post-term births, investigate differences in clinical characteristics, and assess the risk of adverse neonatal outcome. Methods This prospective observational study included 315 singleton births with gestational age (GA) > 36 weeks + 6 days meeting the local criteria for referral to placental histopathologic examination. We applied the Amsterdam criteria to classify the placentas. Births were categorized according to GA; early-term (37 weeks + 0 days to 38 weeks + 6 days), term (39 weeks + 0 days to 40 weeks + 6 days), late-term (41 weeks + 0 days to 41 weeks + 6 days), and post-term births (≥ 42 weeks + 0 days). The groups were compared regarding placental pathology findings and clinical characteristics. Adverse neonatal outcomes were defined as 5-minute Apgar score < 7, umbilical cord artery pH < 7.0, admission to the neonatal intensive care unit or intrauterine death. A composite adverse outcome included one or more adverse outcomes. The associations between placental pathology, adverse neonatal outcomes, maternal and pregnancy characteristics were evaluated by logistic regression analysis. Results Late-term and post-term births exhibited significantly higher rates of histologic chorioamnionitis (HCA), fetal inflammatory response, clinical chorioamnionitis (CCA) and transfer to neonatal intensive care unit (NICU) compared to early-term and term births. HCA and maternal smoking in pregnancy were associated with adverse outcomes in an adjusted analysis. Nulliparity, CCA, emergency section and increasing GA were all significantly associated with HCA. Conclusions HCA was more prevalent in late and post-term births and was the only factor, along with maternal smoking, that was associated with adverse neonatal outcomes. Since nulliparity, CCA and GA beyond term are associated with HCA, this should alert the clinician and elicit continuous intrapartum monitoring for timely intervention.

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Fetal death: Expert consensus of the French College of Obstetricians and Gynecologists

Garabedian,

Sibiude,

Anselem

et al. 2024

Intl J Gynecology & Obste

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Fetal death is defined as the spontaneous cessation of cardiac activity after 14 weeks gestational age (GA). Regarding prevention of fetal death in the general population, it is not recommended to counsel or prescribe rest, aspirin, vitamin A, vitamin D, or micronutrient supplementation; systematically look for nuchal cord during prenatal screening ultrasound; or perform systematic antepartum monitoring by cardiotocography for the sole purpose of reducing the risk of fetal death. It is recommended to offer vaccination against influenza in epidemic periods and against SARS‐CoV‐2. Regarding evaluation in the event of fetal death, it is recommended that a fetal autopsy and anatomopathologic examination of the placenta be performed; chromosomal analysis be performed by microarray testing, rather than by conventional karyotype (with postnatal sampling of the fetal placental surface preferred for genetic purposes); testing for antiphospholipid antibodies be performed, with systematic Kleihauer–Betke testing and for irregular agglutinins; and summary consultation to discuss these examination results be offered. Regarding announcement and support, it is recommended that fetal death be announced without ambiguity, using simple words adapted to each situation, after which the couple should be supported with empathy across the different stages of their care. Regarding patient management in cases of fetal death, it is recommended that: in the absence of risks for disseminated intravascular coagulation or maternal demise, the patient's wishes regarding the timing between the fetal death diagnosis and labor induction should be considered; return home is possible, according to the patient's wishes; in all situations except maternal life‐threatening emergencies, the preferred mode of delivery is vaginal, regardless of previous cesarean section(s); mifepristone 200 mg be prescribed at least 24 h before induction; and perimedullary analgesia be initiated at the start of induction if requested by the patient, regardless of GA. Of note, there is insufficient evidence to recommend either the administration route (i.e., vaginal or oral) of misoprostol or prostaglandin type. Regarding the risk of recurrence after unexplained fetal death: the incidence does not appear to be increased in subsequent pregnancies; in cases with a history of fetal death due to vascular problems, low‐dose aspirin is recommended to reduce perinatal morbidity (otherwise, evidence is insufficient to recommend the prescription of aspirin); no optimal delay in initiating another pregnancy should be recommended based solely on a history of fetal death; fetal heart rate monitoring is not indicated based solely on a history of fetal death; although systematic labor induction is not recommended, induction may be considered depending on the context and parental request, and considering fetal age, benefits, and risks, especially before 39 weeks GA. Note that if the cause of fetal death is identified, management should be adjusted on a case‐by‐case basis. Regarding fetal death in a twin pregnancy, it is recommended that the surviving twin be examined immediately upon fetal death diagnosis; in a dichorionic twin pregnancy, preterm delivery induction is not recommended; in a monochorionic twin pregnancy, the surviving twin should be immediately evaluated for signs of acute fetal anemia, with weekly ultrasound monitoring for the first month, though immediate labor induction is not recommended.

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Is the increasing prevalence of labor induction accompanied by changes in pregnancy outcomes? An observational study of all singleton births at gestational weeks 37–42 in Norway during 1999–2019

Cited by 12 publications

References 30 publications

Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population‐based cohort study

Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population‐based cohort study

Placental pathology and neonatal morbidity: exploring the impact of gestational age at birth

Fetal death: Expert consensus of the French College of Obstetricians and Gynecologists

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