Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial

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Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS) : multicentre, open label, randomised, superiority trial

Wennerholm, U. B. (författare): Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden

Saltvedt, S. (författare): Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Schweden

Wessberg, A. (författare): Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Schweden

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Alkmark, M. (författare): Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden

Bergh, C. (författare): Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden

Wendel, Brismar S. (författare): Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Schweden

Fadl, Helena, 1965- (författare): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Obstetrics and Gynaecology

Jonsson, M. (författare): Department of Women’s and Children’s Health, Uppsala University, Uppsala, Schweden

Ladfors, L. (författare): Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden

Sengpiel, V (författare): Department of Obstetrics and Gynecology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, Department of Obstetrics and Gynecology, Göteborg, Schweden

Wesström, J. (författare): Center for Clinical Research Dalarna, Uppsala University, Uppsala, Schweden

Wennergren, G. (författare): Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden

Wikström, A. K. (författare): Department of Women’s and Children’s Health, Uppsala University, Uppsala, Schweden

Elden, H. (författare): Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Schweden

Stephansson, O. (författare): Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Schweden

Hagberg, H. (författare): Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden

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2020-10-07
2020
Engelska.
Ingår i: Geburtshilfe und Frauenheilkunde. - : Georg Thieme Verlag KG. - 0016-5751 .- 1438-8804. ; 80:10, s. E76-E76

Relaterad länk:: https://doi.org/10.1...; visa fler...; http://uu.diva-porta...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; visa färre...

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Objective: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with low risk pregnancies compared with expectant management and induction at 42 weeks.Methods: A multicenter, randomised controlled superiority trial.Women with low risk singleton pregnanies (n = 2760) were randomised to either induction or expectant management group. The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score < 7 at five minutes, pH < 7.00 or metabolic acidosis (pH < 7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, obstetric brachial plexus injury. Primary analysis was by intention to treat.Results: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group (no deaths compared to six deaths, p = 0.03). The primary outcome did not differ: 2.4 % (33/1381) in the induction group and 2.2 % (31/1379) in the expectant management group (RR 1.06, 95 %CI 0.65 to 1.73; p = 0.90). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups.Conclusions: There was no significant difference in the primary composite outcome when comparing induction at 41 weeks with expectant management and induction at 42. However, a reduction of the secondary outcome perinatal mortality was observed without increasing adverse maternal outcomes. To offer induction at 41 weeks could be one of few interventions that reduces the rate of stillbirths.

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Av författaren/redakt...: Wennerholm, U. B ...; Saltvedt, S.; Wessberg, A.; Alkmark, M.; Bergh, C.; Wendel, Brismar ...; visa fler...; Fadl, Helena, 19 ...; Jonsson, M.; Ladfors, L.; Sengpiel, V; Wesström, J.; Wennergren, G.; Wikström, A. K.; Elden, H.; Stephansson, O.; Hagberg, H.; visa färre...

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Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS) : multicentre, open label, randomised, superiority trial

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