Document Detail


Induction of labor as compared with serial antenatal monitoring in post-term pregnancy. A randomized controlled trial. The Canadian Multicenter Post-term Pregnancy Trial Group.
MedLine Citation:
PMID:  1584259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The rates of perinatal mortality and neonatal morbidity are higher for post-term pregnancies than for term pregnancies. It is not known, however, whether the induction of labor results in better outcomes than does serial fetal monitoring while awaiting spontaneous labor. METHODS: We studied 3407 women with uncomplicated pregnancies of 41 or more weeks' duration. The women were randomly assigned to undergo induction of labor or to have serial antenatal monitoring and spontaneous labor unless there was evidence of fetal or maternal compromise, in which case labor was induced or cesarean section was performed. In the induction group, labor was induced by the intracervical application of prostaglandin E2. Serial antenatal monitoring consisted of counts of fetal kicks, nonstress tests, and assessments of amniotic-fluid volume. The outcomes we measured were the rates of perinatal mortality, neonatal morbidity, and delivery by cesarean section. RESULTS: Among the 1701 women in the induction group, 360 (21.2 percent) underwent cesarean section, as compared with 418 (24.5 percent) of the 1706 women in the monitoring group (P = 0.03). This difference resulted from a lower rate of cesarean section performed because of fetal distress among the women in the induction group (5.7 percent vs. 8.3 percent, P = 0.003). When two infants with lethal congenital anomalies were excluded, there were no perinatal deaths in the induction group and two stillbirths in the monitoring group (P not significant). The frequency of neonatal morbidity was similar in the two groups. CONCLUSIONS: In post-term pregnancy, the induction of labor results in a lower rate of cesarean section than serial antenatal monitoring; the rates of perinatal mortality and neonatal morbidity are similar with the two approaches to management.
Authors:
M E Hannah; W J Hannah; J Hellmann; S Hewson; R Milner; A Willan
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  326     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1992 Jun 
Date Detail:
Created Date:  1992-06-16     Completed Date:  1992-06-16     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1587-92     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, Women's College Hospital, University of Toronto, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cesarean Section
Dinoprostone / administration & dosage
Female
Fetal Death / etiology
Fetal Distress / diagnosis
Fetal Monitoring* / methods
Humans
Infant Mortality
Infant, Newborn
Labor, Induced* / methods
Pregnancy
Pregnancy Outcome
Pregnancy, Prolonged*
Chemical
Reg. No./Substance:
363-24-6/Dinoprostone
Comments/Corrections
Comment In:
N Engl J Med. 1992 Jun 11;326(24):1628-9   [PMID:  1584266 ]
Erratum In:
N Engl J Med 1992 Jul 30;327(5):368

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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