Re: Effect of labour induction on rates of stillbirth and cesarean section in post-term pregnancies
From: art fougner, md (evsono@pipeline.com)
Wed May 5 08:18:20 1999
so once again "The Best AntePartum is a PostPartum!"
Art
At Tue, 4 May 1999, John Robertson M.D. wrote:
>
>Thought I would like to draw your attention to a recent article in the
>Canadian Medical Association Journal. John
>
>Effect of labour induction on rates of stillbirth and cesarean section
>in post-term pregnancies
>
>Andrea K. Sue-A-Quan,*† MSc; Mary E. Hannah,*†‡ MD, CM, MSc; Marsha M.
>Cohen,†‡ MSc, MD; Gary A. Foster,† PhD; Robert M. Liston,§ MB, ChB
>
>CMAJ 1999;160:1145-49
>
>--
>--------------------------------------------------------------------------------
>>From *the Department of Obstetrics and Gynaecology, Sunnybrook & Women's
>--------------------------------------------------------------------------------
>College Health Sciences Centre and University of Toronto, Toronto, Ont.;
>--------------------------------------------------------------------------------
>†the University of Toronto Maternal Infant and Reproductive Health
>Research Unit, Centre for Research in Women's Health, Toronto, Ont.;
>‡the Clinical Epidemiology and Health Care Research Program, University
>of Toronto; and §the Division of MaternalFetal Medicine, Department of
>Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
>This article has been peer reviewed.
>
>Correspondence to: Dr. Mary E. Hannah, University of Toronto Maternal
>Infant and Reproductive Health Research Unit, Centre for Research in
>Women's Health, 714790 Bay St., Toronto ON M5G 1N8; fax 416 351-3771;
>mary.hannah@utoronto.ca
>
>© 1999 Canadian Medical Association (abstract)
>
>--------------------------------------------------------------------------------
>Abstract
>--------------------------------------------------------------------------------
>Background: Meta-analyses of randomized controlled trials suggest that
>--------------------------------------------------------------------------------
>elective induction of labour at 41 weeks' gestation, compared with
>expectant management with selective labour induction, is associated with
>fewer perinatal deaths and no increase in the cesarean section rate. The
>authors studied the changes over time in the rates of labour induction
>in post-term pregnancies in Canada and examined the effects on the rates
>of stillbirth and cesarean section.
>
>Methods: Changes in the proportion of total births at 41 weeks' and at
>42 or more weeks' gestation, and in the rate of stillbirths at 41 or
>more weeks' (versus 40 weeks') gestation in Canada between 1980 and 1995
>were determined using data from Statistics Canada. Changes in the rates
>of labour induction and cesarean section were determined using data from
>hospital and provincial sources.
>
>Results: There was a marked increase in the proportion of births at 41
>weeks' gestation (from 11.9% in 1980 to 16.3% in 1995) and a marked
>decrease in the proportion at 42 or more weeks (from 7.1% in 1980 to
>2.9% in 1995). The rate of stillbirths among deliveries at 41 or more
>weeks' gestation decreased significantly, from 2.8 per 1000 total births
>in 1980 to 0.9 per 1000 total births in 1995 (p < 0.001). The
>stillbirth rate also decreased significantly among births at 40 weeks'
>gestation, from 1.8 per 1000 total births in 1980 to 1.1 per 1000 total
>births in 1995 (p < 0.001). The magnitude of the decrease in the
>stillbirth rate at 41 or more weeks' gestation was greater than that at
>40 weeks' gestation (p < 0.001). All hospital and provincial sources of
>data indicated that the rate of labour induction increased significantly
>between 1980 and 1995 among women delivering at 41 or more weeks'
>gestation. The associated changes in rates of cesarean section were
>variable.
>
>Interpretation: Between 1980 and 1995 clinical practice for the
>management of post-term pregnancy changed in Canada. The increased rate
>of labour induction at 41 or more weeks' gestation may have contributed
>to the decreased stillbirth rate but it had no convincing influence
>either way on the cesarean section rate.
>
>--
>J.G.M.Robertson MD, 109-9181 Main St. Chilliwack, B.C. V2P 4M9, Canada
>(604) 793-9988 e-mail john.robertson@obgyn.net
>Who is wise and understanding among you? Let him show it by his good life,
>by deeds done in the humility that comes from wisdom. James 3 vs 13, NIV
>
--
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
