Management of late-term pregnancy in midwifery- and obstetrician-led care

Abstract

Management of late-term pregnancy in midwifery- and obstetrician-led care. Background Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy. Methods Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions. Results The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units ( p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001). Conclusions Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies. Electronic supplementary material The online version of this article (10.1186/s12884-019-2294-7) contains supplementary material, which is available to authorized users.

Application of CEEMD noise reduction algorithm in ultrasound imaging in evaluating fetuses with abnormal glucose metabolism in late pregnancy

“…The blood flow resistance index PI, RI, S/D was lower than that of normal pregnant women, but no adverse outcome occurred. [7][8][9][10] Results of this study MCA-PI poor prognosis group, MCARI, RI ratio (MCA/UA) are lower than the good prognosis group, Ut-A-PI poor prognosis group than good prognosis group, the differences were statistically significant (all P<0.05), in line with cerebral protection effect, consistent with the findings. When MCA-PI<1.56 is taken as the critical value, the sensitivity and specificity were 91.18%, 80.00%, area under the curve 0.800, consistent with previous studies.…”

“…The blood flow resistance index PI, RI, S/D was lower than that of normal pregnant women, but no adverse outcome occurred. 7 - 10 …”

Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials

“…In the SWEPIS trial, it usually included an antenatal visit performed by a midwife with a clinical assessment and auscultation of fetal heart rate. In the INDEX trial, it generally included clinical assessment and assessment of the fetus with ultrasound, cardiotocography, and extra checks between 41 and 42 weeks [ 40 ]. This could be reflected in the higher rate of medical inductions for fetal and maternal reasons between 41 and 42 weeks in the INDEX expectant management group compared with the expectant group of the SWEPIS trial, though whether this contributed to a lower perinatal mortality rate is unknown and makes us aware that further studies are needed to evaluate the effect of screening regimes in late-term pregnancy.…”

Elective induction of labour and expectant management in late-term pregnancy: A prospective cohort study alongside the INDEX randomised controlled trial

“…Though a positive effect of fetal monitoring (ultrasound and/or CTG surveillance) has not been established in trials so far, a difference in the monitoring of the fetal condition in late-term pregnancy was noticed for Sweden and The Netherlands. All stillbirths in the SWEPIS trial occurred in Swedish regions outside the Stockholm region (19 hospitals) where no regular fetal monitoring was performed between 41 and 42 weeks (6/822), whereas fetal monitoring in late-term pregnancy has a prominent place in maternity care in the Netherlands the last decade [10] . In the Stockholm region, which accounted for half of the participants of the SWEPIS study, ultrasound for biometry and amniotic fluid measurement was performed routinely at 41 weeks before inclusion.…”

“…Since trials are designed to evaluate outcomes by comparing management strategies, whereas in an observational design outcomes of daily practice are evaluated [10] . This raises the question if characteristics and clinical outcomes of those women who participate in a trial differ from women who decline participation.…”