CONTRAINDICATIONS Table 1 Neonatal and Infant Mortality for Singleton Births From 34 Weeks of Gestation to 41 Weeks of Gestation Neonatal Mortality ID: 1042513
Download Presentation The PPT/PDF document "MEDICAL INDICATIONS FOR INDUCTION" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1.
2.
3.
4.
5. MEDICAL INDICATIONS FOR INDUCTION
6. CONTRAINDICATIONS —
7.
8.
9.
10.
11. Table 1. Neonatal and Infant Mortality for Singleton Births From 34 Weeks of Gestation to 41 Weeks of GestationNeonatal Mortality: Neonatal Deaths per 1,000 BirthsInfant Mortality: Infant Deaths per 1,000 BirthsGA, WeekTotalCountRateRR (95% CI)CountRateRR (95% CI)3450,7173597.19.5 (8.4–10.8)a59911.85.4 (4.9–5.9)a3585,2184054.86.4 (5.6–7.2)a7328.63.9 (3.6–4.3) a36156,6924372.83.7 (3.3–4.2)a8905.72.6 (2.4–2.8)a37320,1695461.72.3 (2.1–2.6)a1,3234.11.9 (1.8–2.0)a38674,8927001.01.4 (1.3–1.5)a1,8422.71.00 (reference)39966,2817210.81.00 (reference)2,1182.20.9 (0.9–1.0)40821,9346250.81.0 (0.9–1.1)1,7042.10.9 (0.9–1.0)41407,5933260.81.1 (0.9–1.2)8882.21.1 (1.0–1.1)
12. Adverse Long-Term Infant OutcomesStudies have reported that compared with children born full term, children born late preterm and early term experience additional long-term adverse consequences including :increased hospitalizations up to age 18 slower neurologic development , worse cognitive performance , more school-related problems, and poorer academic achievement. lower performance scores across a range of cognitive and educational measures
13.
14. At 39 weeks or more
15.
16. In the multicenter ARRIVE trialAugust 9, 2018 Engl J Med 2018; 379:513-523 A recent U.S. study called ARRIVE (A Randomised Trial of Induction Versus Expectant Management) has found that: evaluated the perinatal and maternal consequences of planned induction of labor at 39+0 to 39+4 weeks of gestation versus expectant management in over 6100 low-risk nulliparous women across the United States, StudyStart Date: March 2014Study Type: Interventional (Clinical Trial)Actual Study Completion Date: January 2018Actual Primary Completion Date: November 2017
17.
18. induction reduced :the chances of cesarean delivery (18.6 versus 22.2 percent; relative risk [RR] 0.84; 95% CI 0.76-0.93), hypertensive disorders of pregnancy (9.1 versus 14.1 percent; RR 0.64, 95% CI 0.56-0.74), neonatal respiratory support (3.0 versus 4.2 percent; RR 0.71, 95% CI 0.55-0.93), resulted in a statistically similar frequency of the composite outcome of perinatal death or severe neonatal complications (4.3 versus 5.4 percent; RR 0.80, 95% CI 0.64-1.00) induction also increased the median duration of stay on the labor unit (20 versus 14 hours)
19. The ARRIVE study did find that inducing low-risk, first-time mothers with accurately estimated due dates at 39 weeks may help to lower the Cesarean rate from 22% to 19% if care providers follow the same induction practices as they did in this study. The researchers think this is because the risk of Cesarean goes up the longer a pregnancy continues. Longer pregnancies mean more opportunities for potential complications to show up and an increasing willingness by providers to perform a Cesarean.The ARRIVE study does not mean that elective induction at 39 weeks lowers the risk of Cesarean for every individual.
20. So should everyone be induced at 39 weeks to lower the rate of Cesareans?Although this study may be helpful with making informed decisions, it does not mean “everyone” should be induced, and professional organizations have not yet made recommendations recommending elective inductions during the 39th week of pregnancy.
21.
22. STUDY DESIGN: We conducted a retrospective cohort study using chart-abstracted data on births from January 1, 2012, to December 31,2017, at 21 hospitals in the Northwest United States. The study wasrestricted to singleton cephalic hospital births at 39-42weeksgestation. Exclusions included previous cesarean birth, missing data fordelivery type or gestational week at birth, antepartum stillbirth, cesareanbirth without any attempt at vaginal birth, fetal anomaly, gestationaldiabetes mellitus, prepregnancy diabetes mellitus, and prepregnancyhypertension.
23. The rate of cesarean birth for elective inductions at both39 and 40 weeks gestation was compared with the rate in all other ongoing pregnancies in the same gestational week. Maternal outcomes(operative vaginal birth, shoulder dystocia, 3rd- or 4th-degree perineallaceration, pregnancy-related hypertension, and postpartum hemorrhage)and newborn infant outcomes (macrosomia, 5-minute Apgar <7,resuscitation at delivery, intubation, respiratory complications, andneonatal intensive care unit admission) were also compared between elective inductions and on-going pregnancies at 39 and 40 weeks gestation. Logistic regression modeling was used to produce odds ratiosfor outcomes with adjustment for maternal age and body mass index.Results were stratified by parity and gestational week at birth. Duration of hospital stay (admission to delivery, delivery to discharge, and total stay) were compared between elective inductions and on-going pregnancies.
24. RESULTS: A total of 55,694 births were included in the study cohort:4002 elective inductions at 39weeks gestation and 51,692 births at39---42 weeks gestation that were not electively induced. In nulliparouswomen, elective induction at 39 weeks gestation was associatedwith a decreased likelihood of cesarean birth (14.7% vs 23.2%; and an increased rate of operative vaginal birth (18.5% vs 10.8%; compared with on-going pregnancies.In multiparous women, cesarean birth rates were similar in the elective inductions and on-going pregnancies.
25. Elective induction at 39 weeks gestation was associated with a decreased likelihood of pregnancy relatedhypertension in nulliparous (2.2% vs 7.3%; adjusted odds ratio, 0.28; and multiparous women(0.9% vs 3.5%; adjusted odds ratio, 0.24)Term elective induction was not associated with any statistically significant increase in adverse newborn infant outcomes. Elective induction of labor at 39 weeks gestation was associated with increased time from admission to delivery for both nulliparous and multiparous women
26. How to use this informationremains the challenge.
27.