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Created on : 10 Sep 2007
Modified on : 15 Aug 2018

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Bibliographical entry (without author) :

Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. N Engl J Med 1992;326:1587–1592.

Author(s) :

Hannah ME, Hannah WJ, Hellmann J, Hewson S, Milner R, Willan A, and the Canadian Multicenter Post-term Pregnancy Trial Group.

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

BACKGROUND. The rates of perinatal mortality and neonatal morbidity are higher for post-term pregnancies than for term pregnancies. It is not known, however, whether the induction of labor results in better outcomes than does serial fetal monitoring while awaiting spontaneous labor.

METHODS. We studied 3407 women with uncomplicated pregnancies of 41 or more weeks’ duration. The women were randomly assigned to undergo induction of labor or to have serial antenatal monitoring and spontaneous labor unless there was evidence of fetal or maternal compromise, in which case labor was induced or cesarean section was performed. In the induction group, labor was induced by the intracervical application of prostaglandin E2. Serial antenatal monitoring consisted of counts of fetal kicks, nonstress tests, and assessments of amniotic-fluid volume. The outcomes we measured were the rates of perinatal mortality, neonatal morbidity, and delivery by cesarean section.

RESULTS. Among the 1701 women in the induction group, 360 (21.2 percent) underwent cesarean section, as compared with 418 (24.5 percent) of the 1706 women in the monitoring group (P = 0.03). This difference resulted from a lower rate of cesarean section performed because of fetal distress among the women in the induction group (5.7 percent vs. 8.3 percent, P = 0.003). When two infants with lethal congenital anomalies were excluded, there were no perinatal deaths in the induction group and two stillbirths in the monitoring group (P not significant). The frequency of neonatal morbidity was similar in the two groups.

CONCLUSIONS. In post-term pregnancy, the induction of labor results in a lower rate of cesarean section than serial antenatal monitoring; the rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management.

Sumário (português)  :

Resumen (español)  :

Comments :

Argument (français) :

En cas de dépassement de terme, le déclenchement du travail entraîne un taux plus faible de césariennes que le suivi prénatal en série ; les taux de mortalité périnatale et de morbidité néonatale sont similaires aux deux approches de la prise en charge.

Argument (English):

In post-term pregnancy, the induction of labor results in a lower rate of cesarean section than serial antenatal monitoring; the rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management.

Argumento (português):

Na gravidez pós-termo, a indução do parto resulta em menor taxa de cesárea do que o acompanhamento pré-natal em série; as taxas de mortalidade perinatal e morbidade neonatal são semelhantes com as duas abordagens ao manejo.

Argumento (español):

Keywords :

➡ c-section/caesarean ; evidence-based medicine/midwifery ; guidelines ; induction of labor ; post-term pregnancy ; informed consent

Author of this record :

Bernard Bel — 10 Sep 2007
➡ latest update : Bernard Bel — 15 Aug 2018

Related records
Group ‘Discussing induction on term pregnancy
#2067   Bréart G, Goujard J, Maillard F, Chavigny C, Rumeau-Rouquette C, Sureau C. (1982). Comparaison de deux attitudes obstétricales vis-à-vis du déclenchement artificiel du travail à terme. Essai randomisé. J Gynecol Obstet Biol Reprod (Paris). 1982;11(1):107-112. ➡
Pinned by #2010   Chanrachakul B, Herabutya Y. (2003). Postterm with favorable cervix: is induction necessary ? {Thailande} Eur J Obstet Gynecol Reprod Biol. 2003 Feb 10;106(2):154-7. ➡
Pinned by #2015   Goeree R, Hannah M, Hewson S. (1995). Cost-effectiveness of induction of labour versus serial antenatal monitoring in the Canadian Multicentre Postterm Pregnancy Trial. {Canada}. CMAJ. 1995 May 1;152(9):1445-50. ➡
Pinned by #2017   Gelisen O, Caliskan E, Dilbaz S, Ozdas E, Dilbaz B, Ozdas E, Haberal A. (2005). Induction of labor with three different techniques at 41 weeks of gestation or spontaneous follow-up until 42 weeks in women with definitely unfavorable cervical scores. {Turquie}. Eur J Obstet Gynecol Reprod Biol. 2005 Jun 1;120(2):164-9. ➡
Pinned by #2018   Roach VJ, Rogers MS. (1997). Pregnancy outcome beyond 41 weeks gestation. {Chine}. Int J Gynaecol Obstet. 1997 Oct;59(1):19-24. ➡
Pinned by #2064   Francis P. J. M. Vrouenraets, MD, Frans J. M. E. Roumen, MD, PhD, Cary J. G. Dehing, BSt, Eline S. A. van den Akker, MD, Maureen J. B. Aarts, MD and Esther J. T. Scheve, MD (2005). Bishop Score and Risk of Cesarean Delivery After Induction of Labor in Nulliparous Women. Obstetrics & Gynecology 2005;105:690-697. ➡
Pinned by #2069   Savas M. Menticoglou, Philip F. Hall (2002). Routine induction of labour at 41 weeks of gestation: nonsensus consensus. BJOG, 2002 May;109(5): 485-491 ➡
Pinned by #2984   William A. Grobman, M. D., Madeline M. Rice, Ph. D., Uma M. Reddy, M. D., M. P. H., Alan T. N. Tita, M. D., Ph. D., Robert M. Silver, M. D., Gail Mallett, R. N., M. S., C. C. R. C., Kim Hill, R. N., B. S. N., Elizabeth A. Thom, Ph. D., Yasser Y. El-Sayed, M. D., Annette Perez-Delboy, M. D., Dwight J. Rouse, M. D., George R. Saade, M. D., Kim A. Boggess, M. D., Suneet P. Chauhan, M. D., Jay D. Iams, M. D., Edward K. Chien, M. D., Brian M. Casey, M. D., Ronald S. Gibbs, M. D., Sindhu K. Srinivas, M. D., M. S. C. E., Geeta K. Swamy, M. D., Hyagriv N. Simhan, M. D., and George A. Macones, M. D., M. S. C. E. (2018). Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med 2018; 379:513-523 ➡
Pinned by #3037   Cécile Loup, Emmanuelle Phan, Bernard Bel (2008). Le déclenchement systématique, une intervention anodine ? Note du CIANE suite aux RPC « Déclenchement artificiel du travail à partir de 37 semaines d’aménorrhée » publiées par la HAS en avril 2008. ➡
Pinned by #3038   Camille Le Ray (2017). Le déclenchement du travail en France Résultats de l’étude MEDIP (Méthodes de Déclenchement et Issues Périnatales). Etude financée par l’ANSM dans le cadre de l’appel d’offre jeunes chercheurs 2014. ➡
Pinned by #3039   Judy Slome Cohain (2018). Critique of Grobman etal. and the ARRIVE RCT to induce birth at 39 weeks. Conference: Midwifery Today, September. ➡
Discussion (display only in English)
15 Aug 2018 10:55[FR] 31% des femmes placées dans le groupe « déclenchement » à 41 semaines d’aménorrhée ont accouché spontanément, tandis que 34% de celles du groupe « surveillance » ont été déclenchées. L’étude ne donne donc qu’une évaluation des risques de l’intention de déclencher par rapport à la surveillance sérielle, avec 21.2% de césariennes dans le premier groupe et 24.5% dans le second. Si l’on refait les calculs en se basant sur le mode d’accouchement réel, on obtient 29% de césariennes parmi les femmes réellement déclenchées et seulement 16% parmi celles qui ont accouché spontanément (Menticoglu & Hall 2002). Ici encore, le biais renverse la balance bénéfice-risque en faveur du déclenchement ; or cette étude a fortement influencé les Clinical Practice Guidelines de la SOGC en 1997.
Bernard Bel
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