Induction at 41 weeks may cut perinatal complications for low-risk pregnancies
FROM BMJ
The investigators noted several limitations, such as the noninferiority study design, use of composite adverse perinatal outcome, and lack of stratification by parity that led to an imbalance between the induction and expectant management groups.
“If the composite outcome is interpreted straightforwardly, there is a small benefit of induction at 41 weeks that could justify standard induction at 41 weeks,” Ms. Keulen and colleagues wrote.
“It could be argued, however, that a change of policy to earlier induction, concerning roughly one-fifth of all women with a singleton pregnancy, is too rigorous in light of the relatively low incidence of perinatal mortality, gestational age associated NICU admission, and Apgar score less than 4 at 5 minutes as indicator for encephalopathy,” they added. “This could justify expectant management if women want to avoid induction.”
This study was supported by a grant from the Netherlands Organisation for Health Research and Development ZonMw. Dr. Ben Willem Mol reported a practitioner fellowship with the National Health and Medical Research Council and is a consultant for ObsEva, Merck, and Guerbet. The other authors reported no relevant conflicts of interest.
SOURCE: Keulen JKJ et al. BMJ. 2019 Feb 20. doi: 10.1136/bmj.l344.
