title: A more liberal approach towards induction of labour in prolonged pregnancy does not result in an adverse labour outcome.
abstract: BACKGROUND
  Discussions among Norwegian obstetricians on how to handle prolonged pregnancies have been ongoing throughout the past decade. In 2011, the Norwegian Directorate of Health recommended a specialist care consultation one week after the estimated date of delivery, implying prompt induction of labour in women at risk. The aim of this study was to compare an expectant management with a more liberal approach towards induction of labour, and to assess how the women responded to these recommendations.
  
  
  METHODS
  A quality assurance study was performed at Stavanger University Hospital in women with a pregnancy length ≥ 290 days. A total of 480 women who delivered prior to the introduction of the new guidelines (control period) were compared with 493 women treated according to the new recommendations (study period).
  
  
  RESULTS
  A total of 421/493 (85%) women in the study period attended the consultation on day 290. Of these, 61% were recommended early induction of labour (within 24 hours) because their pregnancy was a risk pregnancy. Four percent of the women with risk factors awaited spontaneous labour until day 294, versus 20% of low-risk women. When comparing the two periods, we observed an increase in the frequency of induced labour from 38% to 65%, an insignificant elevation of Caesarean section rates from 11.5% to 13.8%, and no significant increase in other interventions or in adverse newborn outcomes.
  
  
  CONCLUSIONS
  A more liberal approach towards induction of labour one week after the estimated date of delivery did not lead to an adverse labour outcome.
  
  
  BACKGROUND
  none.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Stavanger University Hospital, PO Box 8100, NO-4068 Stavanger, Norway. klef@sus.no.
authors.forename: Olav-Andre
authors.initials: OA
authors.lastname: Klefstad
authors.forename: Inger
authors.initials: I
authors.lastname: Økland
authors.forename: Elsa
authors.initials: E
authors.lastname: Lindtjørn
authors.forename: Astrid B
authors.initials: AB
authors.lastname: Rygh
authors.forename: Kristine
authors.initials: K
authors.lastname: Kaada
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hansen
authors.forename: Torbjørn M
authors.initials: TM
authors.lastname: Eggebø
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D009664:Norway; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011273:Pregnancy, Prolonged / Q000628:therapy*; D011785:Quality Assurance, Health Care; D016896:Treatment Outcome; D057832:Watchful Waiting; D055815:Young Adult