Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10773/30268 |
Resumo: | Background: Women of advanced maternal age, defined as >= 35 years at delivery, are at increased risk of multiple complications during pregnancy, with perinatal death being one of the most feared. For instance, the risk of stillbirth at term in this subgroup of women is higher than in younger women, and particularly high beyond 39 weeks of gestation. Induction of labor at 39–40 weeks might help prevent some cases of perinatal death, however, the fact that induction of labor has been historically associated with an increased risk of cesarean delivery and the knowledge that advanced maternal age is an independent risk factor for cesarean delivery are some of the major reasons why clinicians are reluctant to offer elective induction of labor in this particular group. Objective: The aim of the study was to assess if induction of labor in advanced maternal age was associated with increased rates of cesarean delivery when compared to expectant management. Material and methods: We performed an electronic search limited to published articles available between January 2000 and March 2020. Randomized clinical trials and retrospective studies with large cohorts comparing induction of labor with expectant management in singleton pregnancies at term, of women aged >= 35 years were included. The primary outcome was the rate of cesarean delivery in induction of labor versus expectant management, and secondary outcomes were the occurrence of assisted vaginal delivery and postpartum hemorrhage. Results: Eight studies, including 81151 pregnancies (26,631 in the induction group and 54,520 expectantly managed), were included in the analysis. Six of the included studies were randomized clinical trials with the remaining two being observational and retrospective cohort studies. Induction of labor was not associated with a significant increased risk of cesarean delivery (OR 0.97, 95 % CI 0.86–1.1), assisted vaginal delivery (OR 1.12, 95 % CI 0.96–1.32) or postpartum hemorrhage (OR 1.11, 95 % CI 0.88–1.41). Discussion: The belief that induction of labor is associated with an increased risk of cesarean delivery is based on the results of retrospective studies comparing induction with spontaneous labor at the same gestational age. However, at any point in a pregnancy, the comparison should be between induction of labor and expectant management, with the latter contributing to a pregnancy of greater gestation age and not always leading to spontaneous labor. When comparing induction to expectant management, our study shows no significant increase of cesarean section, assisted vaginal delivery or postpartum hemorrhage. Our study was not powered to assess neonatal outcomes, and additional research is needed to confirm whether induction of labor might have a positive effect in preventing stillbirth. Conclusion: Induction of labor at term in advanced maternal age has no significant impact on cesarean delivery rates, assisted vaginal delivery or postpartum hemorrhage, giving additional reassurance to obstetricians who would consider this intervention in this particular subgroup. |
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Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysisCesarean deliveryAdvanced maternal ageInduction of laborMeta-analysisExpectant managementBackground: Women of advanced maternal age, defined as >= 35 years at delivery, are at increased risk of multiple complications during pregnancy, with perinatal death being one of the most feared. For instance, the risk of stillbirth at term in this subgroup of women is higher than in younger women, and particularly high beyond 39 weeks of gestation. Induction of labor at 39–40 weeks might help prevent some cases of perinatal death, however, the fact that induction of labor has been historically associated with an increased risk of cesarean delivery and the knowledge that advanced maternal age is an independent risk factor for cesarean delivery are some of the major reasons why clinicians are reluctant to offer elective induction of labor in this particular group. Objective: The aim of the study was to assess if induction of labor in advanced maternal age was associated with increased rates of cesarean delivery when compared to expectant management. Material and methods: We performed an electronic search limited to published articles available between January 2000 and March 2020. Randomized clinical trials and retrospective studies with large cohorts comparing induction of labor with expectant management in singleton pregnancies at term, of women aged >= 35 years were included. The primary outcome was the rate of cesarean delivery in induction of labor versus expectant management, and secondary outcomes were the occurrence of assisted vaginal delivery and postpartum hemorrhage. Results: Eight studies, including 81151 pregnancies (26,631 in the induction group and 54,520 expectantly managed), were included in the analysis. Six of the included studies were randomized clinical trials with the remaining two being observational and retrospective cohort studies. Induction of labor was not associated with a significant increased risk of cesarean delivery (OR 0.97, 95 % CI 0.86–1.1), assisted vaginal delivery (OR 1.12, 95 % CI 0.96–1.32) or postpartum hemorrhage (OR 1.11, 95 % CI 0.88–1.41). Discussion: The belief that induction of labor is associated with an increased risk of cesarean delivery is based on the results of retrospective studies comparing induction with spontaneous labor at the same gestational age. However, at any point in a pregnancy, the comparison should be between induction of labor and expectant management, with the latter contributing to a pregnancy of greater gestation age and not always leading to spontaneous labor. When comparing induction to expectant management, our study shows no significant increase of cesarean section, assisted vaginal delivery or postpartum hemorrhage. Our study was not powered to assess neonatal outcomes, and additional research is needed to confirm whether induction of labor might have a positive effect in preventing stillbirth. Conclusion: Induction of labor at term in advanced maternal age has no significant impact on cesarean delivery rates, assisted vaginal delivery or postpartum hemorrhage, giving additional reassurance to obstetricians who would consider this intervention in this particular subgroup.Elsevier2021-01-11T11:01:29Z2020-10-01T00:00:00Z2020-10info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10773/30268eng0301-211510.1016/j.ejogrb.2020.08.022Fonseca, Maria JoãoSantos, FernandaAfreixo, VeraSilva, Isabel SantosAlmeida, Maria do Céuinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-02-22T11:58:28Zoai:ria.ua.pt:10773/30268Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:02:23.735881Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
title |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
spellingShingle |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis Fonseca, Maria João Cesarean delivery Advanced maternal age Induction of labor Meta-analysis Expectant management |
title_short |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
title_full |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
title_fullStr |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
title_full_unstemmed |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
title_sort |
Does induction of labor at term increase the risk of cesarean section in advanced maternal age? A systematic review and meta-analysis |
author |
Fonseca, Maria João |
author_facet |
Fonseca, Maria João Santos, Fernanda Afreixo, Vera Silva, Isabel Santos Almeida, Maria do Céu |
author_role |
author |
author2 |
Santos, Fernanda Afreixo, Vera Silva, Isabel Santos Almeida, Maria do Céu |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Fonseca, Maria João Santos, Fernanda Afreixo, Vera Silva, Isabel Santos Almeida, Maria do Céu |
dc.subject.por.fl_str_mv |
Cesarean delivery Advanced maternal age Induction of labor Meta-analysis Expectant management |
topic |
Cesarean delivery Advanced maternal age Induction of labor Meta-analysis Expectant management |
description |
Background: Women of advanced maternal age, defined as >= 35 years at delivery, are at increased risk of multiple complications during pregnancy, with perinatal death being one of the most feared. For instance, the risk of stillbirth at term in this subgroup of women is higher than in younger women, and particularly high beyond 39 weeks of gestation. Induction of labor at 39–40 weeks might help prevent some cases of perinatal death, however, the fact that induction of labor has been historically associated with an increased risk of cesarean delivery and the knowledge that advanced maternal age is an independent risk factor for cesarean delivery are some of the major reasons why clinicians are reluctant to offer elective induction of labor in this particular group. Objective: The aim of the study was to assess if induction of labor in advanced maternal age was associated with increased rates of cesarean delivery when compared to expectant management. Material and methods: We performed an electronic search limited to published articles available between January 2000 and March 2020. Randomized clinical trials and retrospective studies with large cohorts comparing induction of labor with expectant management in singleton pregnancies at term, of women aged >= 35 years were included. The primary outcome was the rate of cesarean delivery in induction of labor versus expectant management, and secondary outcomes were the occurrence of assisted vaginal delivery and postpartum hemorrhage. Results: Eight studies, including 81151 pregnancies (26,631 in the induction group and 54,520 expectantly managed), were included in the analysis. Six of the included studies were randomized clinical trials with the remaining two being observational and retrospective cohort studies. Induction of labor was not associated with a significant increased risk of cesarean delivery (OR 0.97, 95 % CI 0.86–1.1), assisted vaginal delivery (OR 1.12, 95 % CI 0.96–1.32) or postpartum hemorrhage (OR 1.11, 95 % CI 0.88–1.41). Discussion: The belief that induction of labor is associated with an increased risk of cesarean delivery is based on the results of retrospective studies comparing induction with spontaneous labor at the same gestational age. However, at any point in a pregnancy, the comparison should be between induction of labor and expectant management, with the latter contributing to a pregnancy of greater gestation age and not always leading to spontaneous labor. When comparing induction to expectant management, our study shows no significant increase of cesarean section, assisted vaginal delivery or postpartum hemorrhage. Our study was not powered to assess neonatal outcomes, and additional research is needed to confirm whether induction of labor might have a positive effect in preventing stillbirth. Conclusion: Induction of labor at term in advanced maternal age has no significant impact on cesarean delivery rates, assisted vaginal delivery or postpartum hemorrhage, giving additional reassurance to obstetricians who would consider this intervention in this particular subgroup. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-10-01T00:00:00Z 2020-10 2021-01-11T11:01:29Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10773/30268 |
url |
http://hdl.handle.net/10773/30268 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
0301-2115 10.1016/j.ejogrb.2020.08.022 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
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Elsevier |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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