| Systematic review: elective induction of labor versus expectant management of pregnancy. | |
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MedLine Citation:
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PMID: 19687492 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The rates of induction of labor and elective induction of labor are increasing. Whether elective induction of labor improves outcomes or simply leads to greater complications and health care costs is commonly debated in the literature. PURPOSE: To compare the benefits and harms of elective induction of labor and expectant management of pregnancy. DATA SOURCES: MEDLINE (through February 2009), Web of Science, CINAHL, Cochrane Central Register of Controlled Trials (through March 2009), bibliographies of included studies, and previous systematic reviews. STUDY SELECTION: Experimental and observational studies of elective induction of labor reported in English. DATA EXTRACTION: Two authors abstracted study design; patient characteristics; quality criteria; and outcomes, including cesarean delivery and maternal and neonatal morbidity. DATA SYNTHESIS: Of 6117 potentially relevant articles, 36 met inclusion criteria: 11 randomized, controlled trials (RCTs) and 25 observational studies. Overall, expectant management of pregnancy was associated with a higher odds ratio (OR) of cesarean delivery than was elective induction of labor (OR, 1.22 [95% CI, 1.07 to 1.39]; absolute risk difference, 1.9 percentage points [CI, 0.2 to 3.7 percentage points]) in 9 RCTs. Women at or beyond 41 completed weeks of gestation who were managed expectantly had a higher risk for cesarean delivery (OR, 1.21 [CI, 1.01 to 1.46]), but this difference was not statistically significant in women at less than 41 completed weeks of gestation (OR, 1.73 [CI, 0.67 to 4.5]). Women who were expectantly managed were more likely to have meconium-stained amniotic fluid than those who were electively induced (OR, 2.04 [CI, 1.34 to 3.09]). Limitations: There were no recent RCTs of elective induction of labor at less than 41 weeks of gestation. The 2 studies conducted at less than 41 weeks of gestation were of poor quality and were not generalizable to current practice. CONCLUSION: RCTs suggest that elective induction of labor at 41 weeks of gestation and beyond is associated with a decreased risk for cesarean delivery and meconium-stained amniotic fluid. There are concerns about the translation of these findings into actual practice; thus, future studies should examine elective induction of labor in settings where most obstetric care is provided. |
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Authors:
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Aaron B Caughey; Vandana Sundaram; Anjali J Kaimal; Allison Gienger; Yvonne W Cheng; Kathryn M McDonald; Brian L Shaffer; Douglas K Owens; Dena M Bravata |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Review |
Journal Detail:
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Title: Annals of internal medicine Volume: 151 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2009 Aug |
Date Detail:
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Created Date: 2009-08-18 Completed Date: 2009-08-25 Revised Date: 2010-10-07 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 252-63, W53-63 Citation Subset: AIM; IM |
Affiliation:
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Stanford University, Stanford, CA 94305-6019, USA. abcmd@berkeley.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Apgar Score Cesarean Section / statistics & numerical data Delivery, Obstetric / statistics & numerical data* Female Gestational Age Humans Infant, Newborn Infant, Newborn, Diseases / epidemiology* Labor, Induced / adverse effects, statistics & numerical data* Labor, Obstetric Observation Obstetric Labor Complications / epidemiology* Pregnancy Pregnancy Outcome Randomized Controlled Trials as Topic / standards Risk Factors |
| Comments/Corrections | |
Comment In:
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Birth. 2010 Sep;37(3):252-6
[PMID:
20887542
]
Ann Intern Med. 2009 Aug 18;151(4):281-2 [PMID: 19687495 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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