title: Which intrauterine growth restricted fetuses at term benefit from early labour induction? A secondary analysis of the DIGITAT randomised trial.
abstract: OBJECTIVE
  The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT trial) showed that in women with suspected intrauterine growth restriction (IUGR) at term, there were no substantial outcome differences between induction of labour and expectant monitoring. The objective of the present analysis is to evaluate whether maternal or fetal markers could identify IUGR fetuses who would benefit from early labour induction.
  
  
  METHODS
  The DIGITAT trial was a multicenter, parallel and open-label randomised controlled trial in women who had a singleton pregnancy beyond 36+0 weeks' gestation with suspected IUGR (n=650). Women had been randomly allocated to either labour induction or expectant monitoring. The primary outcome was a composite measure of adverse neonatal outcome, defined as neonatal death before hospital discharge, Apgar score <7, umbilical artery pH <7.05, or admission to neonatal intensive care. Using logistic regression modelling, we investigated associations between outcome and 17 markers, maternal characteristics and fetal sonographic and Doppler velocimetry measurements, all collected at study entry.
  
  
  RESULTS
  17 (5.3%) infants in the induction group had an adverse neonatal outcome compared to 20 (6.1%) in the expectant monitoring group. The only potentially informative marker for inducing labour was maternal pre-pregnancy body mass index (BMI). Otherwise, we observed at best weak associations between a benefit from labour induction and maternal age, ethnicity, smoking, parity, pregnancy-induced hypertension or preeclampsia, Bishop score and gestational age, or fetal sonographic markers (gender, estimated fetal weight, body measurements, oligohydramnios, or umbilical artery pulsatility index and end diastolic flow).
  
  
  CONCLUSIONS
  In late preterm and term pregnancies complicated by suspected intrauterine growth restriction, most of the known prognostic markers seem unlikely to be helpful in identifying women who could benefit from labour induction, except for maternal pre-pregnancy BMI.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: P.Tajik@amc.uva.nl.
authors.forename: Parvin
authors.initials: P
authors.lastname: Tajik
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Linda
authors.initials: L
authors.lastname: van Wyk
authors.affiliation: Department of Obstetrics and Gynaecology, Bronovo Hospital, The Hague, The Netherlands.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Boers
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mohammad Hadi
authors.initials: MH
authors.lastname: Zafarmand
authors.affiliation: Department of Obstetrics and Gynaecology, Atrium Medical Centre, Heerlen, The Netherlands.
authors.forename: Frans
authors.initials: F
authors.lastname: Roumen
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Joris A M
authors.initials: JA
authors.lastname: van der Post
authors.affiliation: Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: Martina
authors.initials: M
authors.lastname: Porath
authors.affiliation: Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Maria G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.
authors.forename: Marc E A
authors.initials: ME
authors.lastname: Spaanderdam
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Kwee
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Duvekot
authors.affiliation: Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Bremer
authors.affiliation: Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands.
authors.forename: Friso M C
authors.initials: FM
authors.lastname: Delemarre
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Kitty W M
authors.initials: KW
authors.lastname: Bloemenkamp
authors.affiliation: Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, The Netherlands.
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Christine
authors.initials: C
authors.lastname: Willekes
authors.affiliation: Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Jan M M
authors.initials: JM
authors.lastname: van Lith
authors.affiliation: Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Bossuyt
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands.
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Sicco A
authors.initials: SA
authors.lastname: Scherjon
mesh_terms: D000137:Acid-Base Imbalance / Q000097:blood; D000293:Adolescent; D000328:Adult; D001034:Apgar Score; D015992:Body Mass Index; D005260:Female; D005317:Fetal Growth Retardation / Q000628:therapy*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007745:Labor Onset; D007751:Labor, Induced / Q000379:methods*; D017078:Laser-Doppler Flowmetry; D008297:Male; D011247:Pregnancy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries; D057832:Watchful Waiting; D055815:Young Adult
keywords: Expectant monitoring; Intrauterine growth restriction (IUGR); Labour induction; Treatment selection markers