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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Induction of labor versus expectant management for post-date pregnancy: is there sufficient evidence for a change in clinical practice?

Review published: 2009.

Bibliographic details: Wennerholm U B, Hagberg H, Brorsson B, Bergh C.  Induction of labor versus expectant management for post-date pregnancy: is there sufficient evidence for a change in clinical practice? Acta Obstetricia et Gynecologica Scandinavica 2009; 88(1): 6-17. [PubMed: 19140042]

Quality assessment

This generally well-conducted review concluded that elective induction of labour was associated with a lower rate of meconium aspiration syndrome and caesarean section, but not a lower risk of perinatal mortality, when compared with expectant management for post-date pregnancy. Some caution might be required in interpreting these conclusions because of the poor quality of most of the included trials. Full critical summary

Abstract

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.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2013 University of York.

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