Geburtshilfe Frauenheilkd 2020; 80(10): e76
DOI: 10.1055/s-0040-1717166
Vortrag
Mittwoch, 7.10.2020
Evidenzbasiertes Wissen zur Einleitung

Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial

UB Wennerholm
1   Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden
,
S Saltvedt
2   Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Schweden
,
A Wessberg
3   Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Schweden
,
M Alkmark
1   Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden
,
C Bergh
1   Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden
,
S Brismar Wendel
4   Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Schweden
,
H Fadl
5   Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Schweden
,
M Jonsson
6   Department of Women’s and Children’s Health, Uppsala University, Uppsala, Schweden
,
L Ladfors
1   Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden
,
V Sengpiel
7   Department of Obstetrics and Gynecology, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, Department of Obstetrics and Gynecology, Göteborg, Schweden
,
J Wesström
8   Center for Clinical Research Dalarna, Uppsala University, Uppsala, Schweden
,
G Wennergren
9   Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden
,
AK Wikström
6   Department of Women’s and Children’s Health, Uppsala University, Uppsala, Schweden
,
H Elden
3   Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Schweden
,
O Stephansson
10   Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Schweden
,
H Hagberg
1   Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Schweden
› Author Affiliations
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Objective To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with low risk pregnancies compared with expectant management and induction at 42 weeks.

Methods A multicenter, randomised controlled superiority trial.

Women with low risk singleton pregnanies (n = 2760) were randomised to either induction or expectant management group. The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score < 7 at five minutes, pH < 7.00 or metabolic acidosis (pH < 7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, obstetric brachial plexus injury. Primary analysis was by intention to treat.

Results The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group (no deaths compared to six deaths, p = 0.03). The primary outcome did not differ: 2.4 % (33/1381) in the induction group and 2.2 % (31/1379) in the expectant management group (RR 1.06, 95 %CI 0.65 to 1.73; p = 0.90). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups.

Conclusions There was no significant difference in the primary composite outcome when comparing induction at 41 weeks with expectant management and induction at 42. However, a reduction of the secondary outcome perinatal mortality was observed without increasing adverse maternal outcomes. To offer induction at 41 weeks could be one of few interventions that reduces the rate of stillbirths.



Publication History

Article published online:
07 October 2020

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