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Induction of labour...
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.
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- Alkmark, Mårten, 1973 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Univ Gothenburg, Sahlgrenska Acad, Ctr Perinatal Med & Hlth, Dept Obstet & Gynecol,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Obstet, Reg Vastra Gotaland, Gothenburg, Sweden.,Univ Amsterdam, Amsterdam UMC, Dept Obstet & Gynaecol, Amsterdam Reprod & Dev Res Inst, Amsterdam, Netherlands.
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- Keulen, Judit K J (författare)
- Univ Amsterdam, Amsterdam UMC, Dept Obstet & Gynaecol, Amsterdam Reprod & Dev Res Inst, Amsterdam, Netherlands.
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- Kortekaas, Joep C (författare)
- Radboud Univ Nijmegen Med Ctr, Dept Obstet & Gynaecol, Nijmegen, Netherlands.
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- Bergh, Christina, 1953 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Gothenburg Univ, Dept Obstet & Gynecol, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Reprod Med, Gothenburg, Sweden.
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- van Dillen, Jeroen (författare)
- Radboud Univ Nijmegen Med Ctr, Dept Obstet & Gynaecol, Nijmegen, Netherlands.
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- Duijnhoven, Ruben G (författare)
- Univ Amsterdam, Amsterdam UMC, Dept Obstet & Gynaecol, Amsterdam Reprod & Dev Res Inst, Amsterdam, Netherlands.
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- Hagberg, Henrik, 1955 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Univ Gothenburg, Sahlgrenska Acad, Ctr Perinatal Med & Hlth, Dept Obstet & Gynecol,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Obstet, Reg Vastra Gotaland, Gothenburg, Sweden.
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- Mol, Ben Willem (författare)
- Monash Univ, Dept Obstet & Gynaecol, Monash Med Ctr, Clayton, Vic, Australia.;Univ Aberdeen, Aberdeen Ctr Womens Hlth Res, Aberdeen, Scotland.
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- Molin, Mattias (författare)
- Stat Consulting Grp, Gothenburg, Sweden.
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van der Post, Joris A M (författare)
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- Saltvedt, Sissel (författare)
- Karolinska Institutet
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- Wikström, Anna-Karin, 1965- (författare)
- Uppsala universitet,Klinisk obstetrik
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- Wennerholm, Ulla-Britt, 1948 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för obstetrik och gynekologi,Institute of Clinical Sciences, Department of Obstetrics and Gynecology,Univ Gothenburg, Sahlgrenska Acad, Ctr Perinatal Med & Hlth, Dept Obstet & Gynecol,Inst Clin Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Obstet, Reg Vastra Gotaland, Gothenburg, Sweden.
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- de Miranda, Esteriek (författare)
- Univ Amsterdam, Amsterdam UMC, Dept Obstet & Gynaecol, Amsterdam Reprod & Dev Res Inst, Amsterdam, Netherlands.
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(creator_code:org_t)
- 2020-12-08
- 2020
- Engelska.
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Ingår i: PLoS medicine. - : Public Library of Science (PLoS). - 1549-1676 .- 1549-1277. ; 17:12
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https://doi.org/10.1...
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. Several randomised controlled trials (RCTs) have assessed if induction of labour (IOL) in uncomplicated pregnancies at 41 weeks will improve perinatal outcomes. We performed an individual participant data meta-analysis (IPD-MA) on this subject.We searched PubMed, Excerpta Medica dataBASE (Embase), The Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PsycINFO on February 21, 2020 for RCTs comparing IOL at 41 weeks with expectant management until 42 weeks in women with uncomplicated pregnancies. Individual participant data (IPD) were sought from eligible RCTs. Primary outcome was a composite of severe adverse perinatal outcomes: mortality and severe neonatal morbidity. Additional outcomes included neonatal admission, mode of delivery, perineal lacerations, and postpartum haemorrhage. Prespecified subgroup analyses were conducted for parity (nulliparous/multiparous), maternal age (<35/≥35 years), and body mass index (BMI) (<30/≥30). Aggregate data meta-analysis (MA) was performed to include data from RCTs for which IPD was not available. From 89 full-text articles, we identified three eligible RCTs (n = 5,161), and two contributed with IPD (n = 4,561). Baseline characteristics were similar between the groups regarding age, parity, BMI, and higher level of education. IOL resulted overall in a decrease of severe adverse perinatal outcome (0.4% [10/2,281] versus 1.0% [23/2,280]; relative risk [RR] 0.43 [95% confidence interval [CI] 0.21 to 0.91], p-value 0.027, risk difference [RD] -57/10,000 [95% CI -106/10,000 to -8/10,000], I2 0%). The number needed to treat (NNT) was 175 (95% CI 94 to 1,267). Perinatal deaths occurred in one (<0.1%) versus eight (0.4%) pregnancies (Peto odds ratio [OR] 0.21 [95% CI 0.06 to 0.78], p-value 0.019, RD -31/10,000, [95% CI -56/10,000 to -5/10,000], I2 0%, NNT 326, [95% CI 177 to 2,014]) and admission to a neonatal care unit ≥4 days occurred in 1.1% (24/2,280) versus 1.9% (46/2,273), (RR 0.52 [95% CI 0.32 to 0.85], p-value 0.009, RD -97/10,000 [95% CI -169/10,000 to -26/10,000], I2 0%, NNT 103 [95% CI 59 to 385]). There was no difference in the rate of cesarean delivery (10.5% versus 10.7%; RR 0.98, [95% CI 0.83 to 1.16], p-value 0.81) nor in other important perinatal, delivery, and maternal outcomes. MA on aggregate data showed similar results. Prespecified subgroup analyses for the primary outcome showed a significant difference in the treatment effect (p = 0.01 for interaction) for parity, but not for maternal age or BMI. The risk of severe adverse perinatal outcome was decreased for nulliparous women in the IOL group (0.3% [4/1,219] versus 1.6% [20/1,264]; RR 0.20 [95% CI 0.07 to 0.60], p-value 0.004, RD -127/10,000, [95% CI -204/10,000 to -50/10,000], I2 0%, NNT 79 [95% CI 49 to 201]) but not for multiparous women (0.6% [6/1,219] versus 0.3% [3/1,264]; RR 1.59 [95% CI 0.15 to 17.30], p-value 0.35, RD 27/10,000, [95% CI -29/10,000 to 84/10,000], I2 55%). A limitation of this IPD-MA was the risk of overestimation of the effect on perinatal mortality due to early stopping of the largest included trial for safety reasons after the advice of the Data and Safety Monitoring Board. Furthermore, only two RCTs were eligible for the IPD-MA; thus, the possibility to assess severe adverse neonatal outcomes with few events was limited.In this study, we found that, overall, IOL at 41 weeks improved perinatal outcome compared with expectant management until 42 weeks without increasing the cesarean delivery rate. This benefit is shown only in nulliparous women, whereas for multiparous women, the incidence of mortality and morbidity was too low to demonstrate any effect. The magnitude of risk reduction of perinatal mortality remains uncertain. Women with pregnancies approaching 41 weeks should be informed on the risk differences according to parity so that they are able to make an informed choice for IOL at 41 weeks or expectant management until 42 weeks. Study Registration: PROSPERO CRD42020163174.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Pediatrik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Pediatrics (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
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Alkmark, Mårten, ...
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Keulen, Judit K ...
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Kortekaas, Joep ...
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Bergh, Christina ...
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van Dillen, Jero ...
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Duijnhoven, Rube ...
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Hagberg, Henrik, ...
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Mol, Ben Willem
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Molin, Mattias
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van der Post, Jo ...
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Saltvedt, Sissel
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Wikström, Anna-K ...
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Wennerholm, Ulla ...
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de Miranda, Este ...
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Göteborgs universitet
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