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Created on : 17 Mar 2007
Modified on : 15 Aug 2018

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Bibliographical entry (without author) :

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.

Author(s) :

Goeree R, Hannah M, Hewson S.

Year of publication :


URL(s) :…

Résumé (français)  :

Abstract (English)  :

OBJECTIVE: To determine the cost-effectiveness of induction of labour versus serial fetal monitoring while awaiting spontaneous labour in postterm pregnancies.

DESIGN: Cost-effectiveness and cost-minimization analyses conducted as part of a Canadian multicentre randomized clinical trial.

SETTING: Twenty-two Canadian hospitals, of which 19 were teaching hospitals and 3 were community hospitals.

PATIENTS: Women with uncomplicated pregnancies of 41 or more weeks’ gestation were randomly assigned to induction of labour or serial antenatal monitoring. Of the 3418 women enrolled, no data were received on 11. Therefore, results were based on data from 1701 women in the induction arm of the study and 1706 women in the monitoring arm.

MAIN OUTCOME MEASURES: Perinatal mortality and neonatal morbidity, rates of cesarean section and health care costs. Hospital costing models were developed specifically for the study. Data on use of major resources (e.g., length of hospital stay, surgical procedures, major diagnostic tests and procedures, and medications) for all trial participants were collected and combined with data on minor tests and procedures (e.g., laboratory tests) abstracted from a detailed review of medical records of a sample of patients.

RESULTS: Because the results of the clinical trial showed a nonsignificant difference in perinatal mortality and neonatal morbidity between the induction and monitoring arms, the authors conducted a cost-minimization rather than a cost-effectiveness analysis. The mean cost per patient with a postterm pregnancy managed through monitoring was $3132 (95% confidence interval [CI] $3090 to $3174) and per patient who underwent induction of labour was $2939 (95% CI $2898 to $2981), for a difference of $193. The significantly higher (p < 0.0001) mean cost per patient in the monitoring arm was due mainly to the costs of additional monitoring and the significantly higher rates of cesarean section among these patients. Estimated conservatively, the savings resulting from a universal policy of managing postterm pregnancies by induction of labour in Canada may be as high as $8 million a year.

CONCLUSIONS: A policy of managing postterm pregnancy through induction of labour not only results in more favourable outcomes than a monitoring strategy but does so at a lower cost.

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Keywords :

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

Author of this record :

Cécile Loup — 17 Mar 2007
➡ latest update : Bernard Bel — 15 Aug 2018

Related records
Group ‘Discussing induction on term pregnancy
#2070   Hannah ME, Hannah WJ, Hellmann J, Hewson S, Milner R, Willan A, and the Canadian Multicenter Post-term Pregnancy Trial Group. (1992). 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. ➡
#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 #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 11:42[EN] Voir discussion méthodologique sur la page
Le tirage au sort a placé 1701 femmes dans le groupe « déclenchement » et 1706 dans le groupe « surveillance ». L’article ne précise pas combien de femmes du groupe « déclenchement » ont accouché spontanément avant l’intervention. Or il est vraisemblable que le biais soit encore plus marqué que dans l’étude de Roach & Rogers (1997 puisque le délai entre tirage au sort et intervention a été de 4 jours. Ce biais pourrait expliquer que les taux de césariennes soit moins élevé (21.2%) pour le groupe « déclenchement » que pour le groupe « surveillance » (24.5%). Il serait très important de connaître le détail des nombres de césariennes en fonction des accouchements réellement déclenchés versus spontanés car cette étude à grande échelle a un poids prépondérant dans la méta-analyse Cochrane (Gulmezoglu et al. 2007) et fait pencher la balance en faveur d’une apparence de non-augmentation du risque de césarienne en cas de déclenchement, sur laquelle s’appuient nombre de professionnels. (Cette étude s’efforce principalement de montrer que le coût du déclenchement est moindre que celui de la surveillance sérielle.)
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