Open AccessInduction of labor versus expectant management for post‐date pregnancy: Is there sufficient evidence for a change in clinical practice?
Author(s) -
WENNERHOLM ULLABRITT,
HAGBERG HENRIK,
BRORSSON BENGT,
BERGH CHRISTINA
Publication year - 2009
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1080/00016340802555948
Subject(s) - medicine , meta analysis , cinahl , randomized controlled trial , obstetrics , induction of labor , relative risk , expectant management , pregnancy , systematic review , medline , confidence interval , cochrane library , gynecology , gestation , surgery , psychological intervention , nursing , biology , political science , law , genetics
Objectives . To compare perinatal and maternal outcomes between elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Design . Systematic review and meta‐analysis. Methods . We searched PubMed, CINAHL, Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effectiveness (DARE) and PsycINFO (1980 to November, 2007). Inclusion criteria were systematic reviews and randomized controlled trials comparing elective induction of labor versus expectant management of pregnancies at 41 weeks and beyond. Three or more reviewers independently read and evaluated all selected studies. Data were extracted and analyzed using Review Manager Software. Main outcome measures . Perinatal mortality. Results . Thirteen trials fulfilled the inclusion criteria for the meta‐analysis. Elective induction of labor was not associated with lower risk of perinatal mortality compared to expectant management (relative risks (RR): 0.33; 95% confidence intervals (CI): 0.10–1.09). Elective induction was associated with a significantly lower rate of meconium aspiration syndrome (RR: 0.43; 95% CI: 0.23–0.79). More women randomized to expectant management were delivered by cesarean section (RR: 0.87; 95% CI: 0.80–0.96). Conclusions . The meta‐analysis illustrated a problem with rare outcomes such as perinatal mortality. No individual study with adequate sample size has been published, nor would a meta‐analysis based on the current literature be sufficient. The optimal management of pregnancies at 41 weeks and beyond is thus unknown.