title: Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the HYPITAT and DIGITAT trials.
abstract: OBJECTIVE
  To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term.
  
  
  METHODS
  Secondary analysis of data from two randomised clinical trials.
  
  
  METHODS
  Data were collected in two nationwide Dutch trials.
  
  
  METHODS
  Women with hypertensive disease (HYPITAT trial) or suspected fetal growth restriction (DIGITAT trial) and a Bishop score ≤6.
  
  
  METHODS
  Comparison of outcomes after induction of labour and expectant management.
  
  
  METHODS
  Rates of caesarean section and adverse neonatal outcome, defined as 5-minute Apgar score ≤6 and/or arterial umbilical cord pH <7.05 and/or neonatal intensive care unit admission and/or seizures and/or perinatal death.
  
  
  RESULTS
  Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference -1.1%, 95% CI -5.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference -2.7%, 95% CI -7.6 to 2.2) or adverse neonatal outcome rates (difference -1.5%, 95% CI -4.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord pH <7.05 favouring induction (difference -3.2%, 95% CI -5.6 to -0.9). The number needed to treat to prevent one case of umbilical arterial pH <7.05 was 32.
  
  
  CONCLUSIONS
  We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted.
  
  
  CONCLUSIONS
  Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome.
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: Bernardes
authors.affiliation: Department of Obstetrics & Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Broekhuijsen
authors.affiliation: Department of Obstetrics & Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Koopmans
authors.affiliation: Department of Obstetrics & Gynaecology, Bronovo Hospital, Den Haag, the Netherlands.
authors.forename: K E
authors.initials: KE
authors.lastname: Boers
authors.affiliation: Department of Obstetrics & Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Wyk
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Tajik
authors.affiliation: Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: M G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Obstetrics & Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Scherjon
authors.affiliation: The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, North Adelaide, SA, Australia.
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics & Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Franssen
authors.affiliation: Department of Obstetrics & Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: P P
authors.initials: PP
authors.lastname: van den Berg
authors.affiliation: Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Groen
mesh_terms: D000328:Adult; D001034:Apgar Score; D020070:Cervical Ripening; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005317:Fetal Growth Retardation / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006863:Hydrogen-Ion Concentration; D046110:Hypertension, Pregnancy-Induced / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007751:Labor, Induced / Q000379:methods*; D066087:Perinatal Death; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012640:Seizures / Q000453:epidemiology*; D057832:Watchful Waiting; D055815:Young Adult
keywords: Cervical ripeness; expectant management; fetal growth restriction; hypertensive disease; induction of labour