Study could not show noninferiority of expectant management; outcomes good with both strategies
FRIDAY, March 15, 2019 (HealthDay News) — There may be a small benefit to labor induction in low-risk woman at 41 weeks versus expectant management, though the chances of a good perinatal outcome are high with both strategies, according to a study published online Feb. 20 in The BMJ.
Judit K.J. Keulen, from the University of Amsterdam, and colleagues examined a composite of perinatal mortality and neonatal morbidity outcomes for low-risk women randomly assigned to induction of labor at 41 weeks (900 women) or expectant management until 42 weeks (901 women). The women had uncomplicated singleton pregnancies and were seen at 123 primary care midwifery practices and 45 hospitals (secondary care) in the Netherlands from 2012 through 2016.
The researchers found adverse perinatal outcomes in 1.7 percent of women in the induction group versus 3.1 percent in the expectant management group (P = 0.22 for noninferiority). In the induction group, 11 infants had an Apgar score <7 at five minutes versus 23 in the expectant management group (relative risk [RR], 0.48; 95 percent confidence interval, 0.23 to 0.98). There were no cases in the induction group of an Apgar score <4 at five minutes versus three cases in the expectant management group. There was one fetal death in the induction group and two in the expectant management group but no neonatal deaths. There were three neonatal intensive care unit admissions in the induction group versus eight in the expectant management group (RR, 0.38; 95 percent confidence interval, 0.1 to 1.41). Overall, no significant difference was found in composite adverse maternal outcomes or in cesarean section rate between the groups.
“The results of this new trial are not sufficiently conclusive to change current practice,” write the authors of an accompanying editorial.
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