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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 :

1992

URL(s) :

http://content.nejm.org/cgi/content/abstract/326/2…
https://doi.org/10.1056/NEJM199206113262402

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