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

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Decline in stillbirths and perinatal mortality after implementation of a more aggressive induction policy in post-date pregnancies : a nationwide register study. / Zizzo, Anne R.; Kirkegaard, Ida; Pinborg, Anja; Ulbjerg, Niels.

In: Acta Obstetricia et Gynecologica Scandinavica, Vol. 96, No. 7, 07.2017, p. 862-867.

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@article{40c28b75c4f740eba43d7d2b71e9d84b,
title = "Decline in stillbirths and perinatal mortality after implementation of a more aggressive induction policy in post-date pregnancies: a nationwide register study",
abstract = "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.",
keywords = "Stillbirth, prolonged pregnancy, induced labor, epidemiology, ANTEPARTUM STILLBIRTH, RISK, FETAL, LABOR",
author = "Zizzo, {Anne R.} and Ida Kirkegaard and Anja Pinborg and Niels Ulbjerg",
year = "2017",
month = jul,
doi = "10.1111/aogs.13113",
language = "English",
volume = "96",
pages = "862--867",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
issn = "0001-6349",
publisher = "JohnWiley & Sons Ltd.",
number = "7",

}

RIS

TY - JOUR

T1 - Decline in stillbirths and perinatal mortality after implementation of a more aggressive induction policy in post-date pregnancies

T2 - a nationwide register study

AU - Zizzo, Anne R.

AU - Kirkegaard, Ida

AU - Pinborg, Anja

AU - Ulbjerg, Niels

PY - 2017/7

Y1 - 2017/7

N2 - 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.

AB - 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.

KW - Stillbirth

KW - prolonged pregnancy

KW - induced labor

KW - epidemiology

KW - ANTEPARTUM STILLBIRTH

KW - RISK

KW - FETAL

KW - LABOR

U2 - 10.1111/aogs.13113

DO - 10.1111/aogs.13113

M3 - Journal article

C2 - 28186614

VL - 96

SP - 862

EP - 867

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - 7

ER -