title: To what extent do English language RCT meta-analysis justify induction of low-risk pregnancy for postdates?
abstract: Induction for postdates in low-risk pregnancy was adopted with the intent to prevent post-term antepartum stillbirth, the most common cause of perinatal death, based on evidence derived in English language RCT meta-analysis. Systematic English language meta-analysis of RCT studies of induction for postdates in low-risk pregnancy report perinatal mortality rates (PMRs) for low-risk pregnancy ranging from 2.6 to 7.6/1000, based on 2-5 stillbirths among 13-16 perinatal deaths, including diabetic pregnancies as well as other high-risk pregnancies irrelevant to the study question. Baseline PMR≥41 weeks in large international databases for high and low risk pregnancies before routine induction 1998-2003 range from 0.9 to 2.4/1000 or about 300% lower than the reported PMR rates for postdate pregnancies in the expectant management arm in English language RCT meta-analysis. Deaths in the first week far exceed stillbirths in the RCT meta-analysis, the opposite of what is expected. These 2 implausible results bring into question the evidence used to justify induction for postdates≥41 weeks.
authors.affiliation: Alon Shvut 37, 90433, Israel. Electronic address: judyslome@hotmail.com.
authors.forename: J S
authors.initials: JS
authors.lastname: Cohain
mesh_terms: D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D007802:Language; D015201:Meta-Analysis as Topic; D011247:Pregnancy; D011273:Pregnancy, Prolonged / Q000453:epidemiology / Q000628:therapy*; D011643:Publishing / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D011908:Rationalization; D012307:Risk Factors
keywords: Antepartum stillbirth; Induction du travail; Induction for postdates; Maternal morbidity; Maternal mortality; Morbidité maternelle; Morbidité périnatale; Mort-né ante-partum; Mortalité maternelle; Mortalité périnatale; Perinatal morbidity; Perinatal mortality