Decline in stillbirths and perinatal mortality after implementation of a more aggressive induction policy in post-date pregnancies: a nationwide register study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

DOI

Introduction. In 2011 Danish national guidelines were changed towards a more aggressive induction and fetal surveillance policy from (1) induction of labor at gestational age (GA) of 42(+0) weeks and (2) no fetal surveillance after 40(+0) weeks to (1) induction of labor between 41(+2) and 41(+6) weeks, (2) earlier induction at 41(+0) weeks in the case of maternal age >40 years or body mass index (BMI) >35 kg/m(2) and (3) fetal surveillance at GA 41(+0) weeks. Material and methods. This national cohort study included all pregnancies that reached 41(+0) weeks of gestation in 2008-2014 (n = 102 167). Multivariate logistic regression analyses were used to estimate risks in the years after (2012-2014) vs. before (2008-2010) new national guidelines, adjusted for maternal age, BMI, and parity. Results. We observed a decline in stillbirths from 0.9%(0) to 0.5%(0) [odds ratio (OR) (adjusted) 0.50, 95% CI 0.29-0.89, p = 0.018]. Furthermore, a decline in perinatal deaths from 1.3%(0) to 0.8%(0) (ORadjusted 0.62, 95% CI 0.39-0.96, p = 0.033) and vacuum extraction (ORadjusted 0.86, 95% CI 0.82-0.90, p = 0.007) was observed. The risk of cesarean section (ORadjusted 0.98, 95% CI 0.94-1.02, p = 0.251), Apgar score below 7 at five minutes (ORadjusted 0.96, 95% CI 0.81-1.14, p = 0.0.678) and admissions to the neonatal department (ORadjusted 1.04, 95% CI 1.00-1.14, p = 0.064) did not change, whereas induction of labor increased from 28.2 to 42.6% (ORadjusted 1.89, 95% CI 1.84-1.95, p <0.001). Conclusions. This study showed a decline in stillbirths and perinatal mortality after implementation of new Danish guidelines for post-date pregnancies. The risk of interventions as cesarean section and vacuum extraction remained stable despite an increase in labor inductions.

Original languageEnglish
JournalActa Obstetricia et Gynecologica Scandinavica
Volume96
Issue7
Pages (from-to)862-867
Number of pages6
ISSN0001-6349
DOIs
Publication statusPublished - Jul 2017

    Research areas

  • Stillbirth, prolonged pregnancy, induced labor, epidemiology, ANTEPARTUM STILLBIRTH, RISK, FETAL, LABOR

See relations at Aarhus University Citationformats

ID: 121630158