title: Temporal trends in fetal mortality at and beyond term and induction of labor in Germany 2005-2012: data from German routine perinatal monitoring.
abstract: OBJECTIVE
  While a variety of factors may play a role in fetal and neonatal deaths, postmaturity as a cause of stillbirth remains a topic of debate. It still is unclear, whether induction of labor at a particular gestational age may prevent fetal deaths.
  
  
  METHODS
  A multidisciplinary working group was granted access to the most recent set of relevant German routine perinatal data, comprising all 5,291,011 hospital births from 2005 to 2012. We analyzed correlations in rates of induction of labor (IOL), perinatal mortality (in particular stillbirths) at different gestational ages, and fetal morbidity. Correlations were tested with Pearson's product-moment analysis (α = 5 %). All computations were performed with SPSS version 22.
  
  
  RESULTS
  Induction rates rose significantly from 16.5 to 21.9 % (r = 0.98; p < 0.001). There were no significant changes in stillbirth rates (0.28-0.35 per 100 births; r = 0.045; p = 0.806). Stillbirth rates 2009-2012 remained stable in all gestational age groups irrespective of induction. Fetal morbidity (one or more ICD-10 codes) rose significantly during 2005-2012. This was true for both children with (from 33 to 37 %, r = 0.784, p < 0.001) and without (from 25 to 31 %, (r = 0.920, p < 0.001) IOL.
  
  
  CONCLUSIONS
  An increase in IOL at term is not associated with a decline in perinatal mortality. Perinatal morbidity increased with and without induction of labor.
authors.affiliation: Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Institute for Integrative Medicine (IfIM), Universität Witten/Herdecke, Gemeinschaftskrankenhaus, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany. schwarz.christiane@mh-hannover.de.|Midwifery Research and Education Unit, Department of Obstetrics, Gynaecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. schwarz.christiane@mh-hannover.de.
authors.forename: Christiane
authors.identifier: http://orcid.org/0000-0002-5496-6332
authors.initials: C
authors.lastname: Schwarz
authors.affiliation: Department of Applied Health Sciences, University of Applied Sciences, Universitätsstraße 105, 44789, Bochum, Germany. rainhild.schaefers@hs-gesundheit.de.
authors.forename: Rainhild
authors.initials: R
authors.lastname: Schäfers
authors.affiliation: School of Health Professions, Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland. christine.loytved@zhaw.ch.
authors.forename: Christine
authors.initials: C
authors.lastname: Loytved
authors.affiliation: Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Institute for Integrative Medicine (IfIM), Universität Witten/Herdecke, Gemeinschaftskrankenhaus, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany. peter.heusser@uni-wh.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Heusser
authors.affiliation: Studiengang Hebammenkunde, Evangelische Hochschule Berlin, Teltower Damm 118-122, 14167, Berlin, Germany. michael.Abou-Dakn@sjk.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Abou-Dakn
authors.affiliation: AQUA-Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, Maschmühlenweg 8-10, 37073, Göttingen, Germany. thomas.Koenig@Aqua-Institut.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: König
authors.affiliation: Gerhard Kienle Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Institute for Integrative Medicine (IfIM), Universität Witten/Herdecke, Gemeinschaftskrankenhaus, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany. bettina.berger@uni-wh.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Berger
mesh_terms: D005260:Female; D005313:Fetal Death; D046689:Fetal Mortality / Q000639:trends*; D005858:Germany / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007751:Labor, Induced / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D066087:Perinatal Death; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D050497:Stillbirth / Q000453:epidemiology; D047929:Term Birth
keywords: Fetal mortality; Induction of labor; Perinatal data; Post-dates; Postmaturity