Obstet Gynecol. 2007 Mar;109(3):609-17.
Induction of labor or serial antenatal fetal monitoring in postterm
pregnancy: a randomized controlled trial.
Heimstad R, Skogvoll E, Mattsson LA, Johansen OJ, Eik-Nes SH, Salvesen
KA.
Departments of Obstetrics and Gynecology and Paediatrics, National
Center for Fetal Medicine, St. Olavs Hospital, Trondheim University
Hospital, Trondheim, Norway. runa.heimstad@ntnu.no
Objectives:
To compare induction of labor at gestational age 41 weeks
with expectant management in regard to neonatal morbidity. Secondary
aims were to assess the effect of these managements on mode of delivery
and maternal complications.
Methods:
Between September 2002 and July
2004, postterm women with singleton cephalic presentation and no
prelabor rupture of membranes were randomly assigned to induction of
labor at 289 days or antenatal fetal surveillance every third day until
spontaneous labor. Main outcome measures were neonatal morbidity,
operative delivery rates, and maternal complications.
Results:
Five
hundred eight women were randomly assigned, 254 in each group. No
differences of clinical importance were observed in women in whom labor
was induced compared with women who were expectantly managed with regard
to the following outcomes: neonates whose 5-minute Apgar score was less
than 7 (three neonates in the induction group compared with four in the
monitoring group, P=.72); neonates whose umbilical cord pH was less than
7 (three compared with two, P=.69); prevalence of cesarean delivery (28
compared with 33, P=.50); or prevalence of operative vaginal delivery
(32 compared with 27, P=.49). In the induction group more women had
precipitate labors (33 compared with 12, P<.01; number needed to treat
was 13), and the duration of second stage of labor was more often less
than 15 minutes (94 compared with 56, P<.01; number needed to treat was
7).
Conclusion:
No differences were found between the induced and
monitored groups regarding neonatal morbidity or mode of delivery, and
the outcomes were generally good.
