title: Has perinatal outcome improved after introduction of a guideline in favour of routine induction and increased surveillance prior to 42 weeks of gestation?: A cross-sectional population-based registry study.
abstract: OBJECTIVE
  To investigate whether new national guidelines of routine induction of labour and increased surveillance in low risk pregnancies at 41+2-5weeks of gestation as an alternative to expectant management until 42+0weeks of gestation has improved perinatal outcome.
  
  
  METHODS
  A questionnaire-based study regarding local induction practices among all Danish delivery units and a cross-sectional population-based registry study based on data from the Danish Medical Birth Registry (DMBR) in the years 2009-2012.
  
  
  METHODS
  Primary outcomes were frequencies of induced labour and perinatal mortality; secondary outcomes were indicators of perinatal morbidity and instrumental delivery rates.
  
  
  RESULTS
  The questionnaire data showed that 22 of the 24 Danish delivery units complied with the new guidelines in 2012. The study population retrieved from the DMBR included 36,845 low-risk pregnancies at or beyond 41+2weeks of gestation. The number of labour inductions within the study population had doubled after implementation of the new guideline. The increased proportion of induced labour did not appear to influence perinatal morbidity or instrumental delivery rates. Perinatal mortality remained steady in the years 2009, 2010 and 2011 whereas a reduction of 60 % was seen in 2012. However, this change was not statistically significant (P = 0.10).
  
  
  CONCLUSIONS
  This population-based study with a high reported adherence to the new national guideline found no changes in instrumental deliveries or perinatal outcomes after implementation of earlier routine induction of labour and increased surveillance in low risk pregnancies.
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark. Electronic address: sanwol@rm.dk.
authors.forename: Sanne Lausen
authors.initials: SL
authors.lastname: Wolff
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
authors.forename: Iben
authors.initials: I
authors.lastname: Lorentzen
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
authors.forename: Agnete Pers
authors.initials: AP
authors.lastname: Kaltoft
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
authors.forename: Heidi
authors.initials: H
authors.lastname: Schmidt
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.
authors.forename: Monique Mensink
authors.initials: MM
authors.lastname: Jeppesen
authors.affiliation: Department of Obstetrics and Gynaecology, Aarhus University Hospital, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Brendstrupgårsdvej 100, 8200 Aarhus N, Denmark; Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Brendstrupgårsdvej 100, 8200 Aarhus N, Denmark.
authors.forename: Rikke Damkjær
authors.initials: RD
authors.lastname: Maimburg
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003718:Denmark; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D007743:Labor, Obstetric; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011273:Pregnancy, Prolonged / Q000453:epidemiology*; D055815:Young Adult
keywords: Induced; Labor; Perinatal mortality; Post-term pregnancy; Practice guidelines; Pregnancy