Induction of labour from 39 weeks in low-risk multiparas with ripe cervixes: A randomised controlled trial

Tan, Peng Chiong and Othman, Aida and Win, Sandar Tin and Hong, Jesrine Gek Shan and Elias, Nurezwana and Omar, Siti Zawiah (2021) Induction of labour from 39 weeks in low-risk multiparas with ripe cervixes: A randomised controlled trial. The Australian and New Zealand Journal of Obstetrics and Gynaecology, 61 (6). pp. 882-890. ISSN 0004-8666, DOI

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Background Induction of labour (IOL) in low-risk nulliparas at 39 weeks reduces caesarean delivery. Multiparas with ripe cervixes typically have vaginal delivery within eight hours. Delivery at night and weekend are associated with higher maternal and neonatal mortality. Aims To evaluate IOL in full-term multiparas with ripe cervixes to achieve delivery at normal working hours and improve maternal satisfaction. Methods A randomised trial was performed in a tertiary hospital in Malaysia. Low-risk multiparas with ripe cervixes (Bishop score >= 6) were recruited at 38(+4)-40(+0) weeks, then randomised to planned labour induction at 39(+0) weeks or expectant care. Primary outcomes were delivery during `normal working hours' 09:00-17:00 hours, Monday-Friday and patient satisfaction by visual numerical rating scale. Results For IOL (n = 80) vs expectant care (n = 80) arms respectively, primary outcomes of delivery at normal working hours was 27/80 (34%) vs 29/78 (37%), relative risk (RR) 0.9, 95% CI 0.5-1.7, P = 0.41, patient satisfaction was 8.0 +/- 1.8 vs 7.8 +/- 1.6, P = 0.41; presentation for spontaneous labour or rupture of membranes were 27/80 (34%) vs 70/79 (89%), RR 0.4, 95% CI 0.3-0.5, P < 0.001; and for labour induction 52/80 (65%) vs 15/79 (19%), RR 3.4, 95% CI 2.1-5.5, P < 0.001. Caesarean delivery was 8/80 (10%) vs 4/79 (5%), RR 2.0, 95% CI 0.62-6.3, P = 0.25; and mean birthweight was 3.1 +/- 0.3 vs 3.3 +/- 0.4 kg, P = 0.06 for IOL vs expectant care, respectively. Conclusion Labour induction in low-risk multiparas does not increase births during working hours or improve patient satisfaction. Antenatal clinic visits and non-birth hospitalisation were significantly reduced.

Item Type: Article
Funders: Universiti Malaya [UM.0000555/HRU.BK]
Uncontrolled Keywords: Amniotomy; Induction of labour; Multiparas; Patient satisfaction; Ripe cervix
Subjects: R Medicine > R Medicine (General)
R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Medicine > Obstetrics & Gynaecology Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 30 Jul 2022 02:16
Last Modified: 30 Jul 2022 02:16

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