title: Induction at 41 weeks increases the risk of caesarean section in a hospital with a low rate of caesarean sections.
abstract: OBJECTIVE
  To analyse the impact of a change in the management of prolonged pregnancies from inducing labour at 42(+0) to induction at 41(0-6).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Analysis of 3563 single pregnancies with cephalic presentation of ≥ 41 weeks of gestation delivered in Cruces University Hospital (Spain). Two cohorts were compared corresponding to before and after the change in the policy on induction.
  
  
  METHODS
  Induction rate, vaginal delivery rate, newborn morbidity and mortality.
  
  
  RESULTS
  The overall rate of caesarean sections in the patients included in the study was 12.8% (19.5% among those induced and 8.4% among those in whom the onset of labour has been spontaneous). The caesarean section rate in cohorts 41(0-6) and 42(+0) were 14.1% and 11.4%, respectively (p=0.01). Though there were more newborns with umbilical cord blood ph<7.10 in cohort 41(0-6) than in the other group (8.7% versus 4.5%; p<0.01), no significant differences were found between cohorts in 5-min Apgar score < 7, number of admissions to the neonatal care unit or perinatal mortality.
  
  
  CONCLUSIONS
  The induction of labour during week 41 in prolonged pregnancies may increase the rate of caesarean sections in hospitals with low rates of caesarean sections.
authors.affiliation: Department of Obstetrics and Gynecology, Cruces University Hospital, Biscay, Spain. jburgoss@sego.es
authors.forename: Jorge
authors.initials: J
authors.lastname: Burgos
authors.forename: Leire
authors.initials: L
authors.lastname: Rodríguez
authors.forename: Borja
authors.initials: B
authors.lastname: Otero
authors.forename: Patricia
authors.initials: P
authors.lastname: Cobos
authors.forename: Carmen
authors.initials: C
authors.lastname: Osuna
authors.forename: María del Mar
authors.initials: Mdel M
authors.lastname: Centeno
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Melchor
authors.forename: Luis
authors.initials: L
authors.lastname: Fernández-Llebrez
authors.forename: Txantón
authors.initials: T
authors.lastname: Martínez-Astorquiza
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007751:Labor, Induced / Q000009:adverse effects* / Q000706:statistics & numerical data; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult