The aim of this study was to evaluate the risk of cesarean and any maternal and perinatal effects of a policy induction of labor in uncomplicated full-term singleton gestations. Searches were performed in an electronic database with the use of a combination of text words related to "induction" and "cesarean section" from inception of each database through December 2014. We included all randomized controlled trials of uncomplicated singleton gestations at full term (ie, between 39 weeks 0/7 days and 40 weeks 6/7 days) with intact membranes randomized to induction of labor or control (ie, expectant management). The primary outcome was the incidence of cesarean delivery. The summary measures were reported as risk ratio (RR) with 95% confidence interval (CI). Five randomized controlled trials, including 844 women, were analyzed. Full-term vertex singleton gestations receiving induction of labor had similar incidence of cesarean delivery compared to controls (9.7% vs 7.5%; RR, 1.25; 95% CI, 0.75-2.08). Rates of spontaneous (75.9% vs 80.2%; RR, 0.95; 95% CI, 0.87-1.02) and operative (13.1% vs 10.6%; RR, 1.22; 95% CI, 0.83-1.81) vaginal delivery were also similar. Induction was associated with similar rates of chorioamnionitis (9.6% vs 8.0%; RR, 1.17; 95% CI, 0.38-3.39), but statistically significantly less blood loss (mean difference -57.59 mL; 95% CI, -83.96 to -31.21) compared to controls. Regarding neonatal outcomes, induction was associated with a significantly lower rate of meconium-stained amniotic fluid (4.0% vs 13.5%; RR, 0.32; 95% CI, 0.18-0.57) and significantly lower mean birthweight (mean difference -135.51 g; 95% CI, -205.24 to -65.77) compared to control group. Induction of labor at full term in uncomplicated singleton gestations is not associated with increased risk of cesarean delivery and has overall similar outcomes compared to expectant management.

Induction of labor at full term in uncomplicated singleton gestations: A systematic review and metaanalysis of randomized controlled trials / Saccone, Gabriele; Berghella, Vincenzo. - In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. - ISSN 0002-9378. - 213:5(2015), pp. 629-636. [10.1016/j.ajog.2015.04.004]

Induction of labor at full term in uncomplicated singleton gestations: A systematic review and metaanalysis of randomized controlled trials

Saccone, Gabriele;
2015

Abstract

The aim of this study was to evaluate the risk of cesarean and any maternal and perinatal effects of a policy induction of labor in uncomplicated full-term singleton gestations. Searches were performed in an electronic database with the use of a combination of text words related to "induction" and "cesarean section" from inception of each database through December 2014. We included all randomized controlled trials of uncomplicated singleton gestations at full term (ie, between 39 weeks 0/7 days and 40 weeks 6/7 days) with intact membranes randomized to induction of labor or control (ie, expectant management). The primary outcome was the incidence of cesarean delivery. The summary measures were reported as risk ratio (RR) with 95% confidence interval (CI). Five randomized controlled trials, including 844 women, were analyzed. Full-term vertex singleton gestations receiving induction of labor had similar incidence of cesarean delivery compared to controls (9.7% vs 7.5%; RR, 1.25; 95% CI, 0.75-2.08). Rates of spontaneous (75.9% vs 80.2%; RR, 0.95; 95% CI, 0.87-1.02) and operative (13.1% vs 10.6%; RR, 1.22; 95% CI, 0.83-1.81) vaginal delivery were also similar. Induction was associated with similar rates of chorioamnionitis (9.6% vs 8.0%; RR, 1.17; 95% CI, 0.38-3.39), but statistically significantly less blood loss (mean difference -57.59 mL; 95% CI, -83.96 to -31.21) compared to controls. Regarding neonatal outcomes, induction was associated with a significantly lower rate of meconium-stained amniotic fluid (4.0% vs 13.5%; RR, 0.32; 95% CI, 0.18-0.57) and significantly lower mean birthweight (mean difference -135.51 g; 95% CI, -205.24 to -65.77) compared to control group. Induction of labor at full term in uncomplicated singleton gestations is not associated with increased risk of cesarean delivery and has overall similar outcomes compared to expectant management.
2015
Induction of labor at full term in uncomplicated singleton gestations: A systematic review and metaanalysis of randomized controlled trials / Saccone, Gabriele; Berghella, Vincenzo. - In: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY. - ISSN 0002-9378. - 213:5(2015), pp. 629-636. [10.1016/j.ajog.2015.04.004]
File in questo prodotto:
File Dimensione Formato  
13 Induction singleton - AJOG - SACCONE.pdf

accesso aperto

Tipologia: Documento in Post-print
Licenza: Accesso privato/ristretto
Dimensione 1.26 MB
Formato Adobe PDF
1.26 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/697732
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 82
  • ???jsp.display-item.citation.isi??? 81
social impact