Can induction of labour reduce risks to my baby?

We will discuss “Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study” by Hedegaard and co-workers from 24 June 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 11 June 2015.

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Start date: 24 June 2015 (the discussion will open for 7 days between 24 June to 1 July)

First hosted discussion session(s) starts at: GMT 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here.

The discussion points are attached below (quoted from the published manuscript)

Scenario

A 38-year-old white woman comes to see you at 37 weeks of gestation in her first pregnancy. She has read in the news that ‘inducing babies at 37 weeks cuts risks of child dying or developing a serious health condition such as cerebral palsy’ (dailym.ai/1Bpwtir). She has an uncomplicated pregnancy and no other medical history. She asks for your advice about the timing of delivery and the possibility of induction of labour. How would you counsel her?

Description of research

Participants

All babies born at or after 37 weeks of gestation in Denmark between 2000 and 2012

Intervention

Implementation of a proactive labour induction practice recommended by Danish clinical guidelines since 2009

Comparison

Outcomes before the implementation of the new guideline (prior to 2009)

Outcomes

Umbillical cord pH < 7.0; Apgar score < 7 at 5 minutes; neonatal death; admission to a neonatal intensive care unit (NICU); cerebral palsy; fetal weight < 4500 g; shoulder dystocia; peripheral nerve injury

Study design

A historical cohort study

Discussion Points

  • Do you routinely offer induction of labour to women similar to the scenario? If yes, when do you recommend delivery?
  • The Danish guidelines recommend induction of labour between 41+3 and 41+5 weeks of gestation. How does this recommendation compare with your local practice?
  • What are the advantages and pitfalls of using a historical cohort study to address this research question?
  • How did the authors address the study limitations in their methods?
  •  Can you briefly summarise the results of this study as a take-home message of one sentence?
  • Has the general media accurately reported the results of this study? (See an example at dailym.ai/1Bpwtir)
  • Would the results of this study influence your management of the woman in the scenario?
  • How would the results of this study influence your daily practice?

Suggested reading

  • Jauniaux E, Kilby M. All twins should be delivered before 38 weeks of gestation: FOR. BJOG 2014;121:1292.

  • Saugstad OD. Twins should be delivered before 38 weeks of gestation: AGAINST. BJOG. 2014 Sep;121(10):1293.

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4 thoughts on “Can induction of labour reduce risks to my baby?

  1. It is hard to ‘advise’ or make a decision for a pregnant woman deemed to have capacity.
    I could go through the pros and cons of some available options and in the end it is her decision.The would include-
    Risks and benefits

    ”Increased risk of perinatal death with expectant management (low risk)
    Lower risk of meconium aspiration syndrome (after 41 weeks of gestation)
    No change in assisted vaginal delivery rates
    No increase in caesarean section rate.”
    No reliable data about cerebral palsy rate/s.

    Unccomplicated prolonged pregnancy dated correctly with an early USS has no evidence base for induction earlier than 41 weeks.
    ”IOL at 41 completed weeks of gestation should be offered to low-risk women. Such a policy is associated with fewer deaths, although the absolute risk is small. There does not seem to be any increased risk of assisted vaginal or abdominal delivery. If the woman chooses to wait for spontaneous labour onset it would be prudent to have regular fetal monitoring as longitudinal epidemiological studies suggest increased risk of perinatal death by increasing gestational age” Gülmezoglu AM, Crowther CA, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2006;(4):CD004945.

    Mozurkewich EJ, Chilimigras J, Koepke E, Keeton K, King VJ. Indications for induction of labour: a best-evidence review. BJOG 2009;116:626–36.
    National Institute for Health and Clinical Excellence. Induction of Labour. Clinical Guideline 70. London: NICE; 2008.

    Historical cohort studies though interesting may not quite be the right type of study to answer this clinical question.
    Reports by lay jouralists i local papers are never a source of validated evidence.

  2. Regarding her query about cerebral palsy-I cant say that there is evidance(grade A) till date.There was an interesting cohort study-http://1.usa.gov/1QqYhQQ.Here bilateral CP was ‘observed’ to be higher in the labour induced group(where maternal risk variables were excluded)-However-The CI’s were wide-and it was based on database searches-(with various baises including reporting biases)-Hence the evidence is not strong to allow any scope for decision making.

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