Intrapartum care
DOI: 10.1111/1471-0528.13007 www.bjog.org
Using inter-institutional practice variation to understand the risks and benefits of routine labour induction at 41+0 weeks JA Hutcheon,a,b S Harper,c EC Strumpf,c,d L Lee,a G Marquettea,b a
Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada b Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada c Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada d Department of Economics, McGill University, Montreal, Quebec, Canada Correspondence: Dr JA Hutcheon, Room C408A, BC Children’s & Women’s Hospital, 4500 Oak Street, Vancouver, British Columbia, Canada V6H 3N1. Email [email protected] Accepted 8 June 2014. Published Online 14 July 2014.
Objective To evaluate the risks and benefits of routine labour
induction at 41+0 weeks’ gestation for mother and newborn. Design Population-based retrospective cohort study of inter-
institutional variation in labour induction practices for women at or beyond 41+0 weeks’ gestation. Population Women in British Columbia, Canada, who remained
pregnant ≥41+0 weeks and delivered at one of the province’s 42 hospitals with >50 annual deliveries, 2008–2012 (n = 14 627). Methods The proportion of women remaining pregnant a week or more past the expected delivery date who were induced at 41+0 or 41+1 weeks’ gestation for an indication of ‘post-dates’ was calculated for each institution. We used instrumental variable analysis (using the institutional rate of labour induction at 41+0 weeks as the instrument) to estimate the effect of labour induction on maternal and neonatal health outcomes. Main outcome measures Caesarean delivery, instrumental
delivery, post-partum haemorrhage, 3rd or 4th degree lacerations, macrosomia, neonatal intensive care unit admission, and 5-minute Apgar score
DOI: 10.1111/1471-0528.13007 www.bjog.org
Using inter-institutional practice variation to understand the risks and benefits of routine labour induction at 41+0 weeks JA Hutcheon,a,b S Harper,c EC Strumpf,c,d L Lee,a G Marquettea,b a
Perinatal Services British Columbia, Provincial Health Services Authority, Vancouver, British Columbia, Canada b Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada c Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada d Department of Economics, McGill University, Montreal, Quebec, Canada Correspondence: Dr JA Hutcheon, Room C408A, BC Children’s & Women’s Hospital, 4500 Oak Street, Vancouver, British Columbia, Canada V6H 3N1. Email [email protected] Accepted 8 June 2014. Published Online 14 July 2014.
Objective To evaluate the risks and benefits of routine labour
induction at 41+0 weeks’ gestation for mother and newborn. Design Population-based retrospective cohort study of inter-
institutional variation in labour induction practices for women at or beyond 41+0 weeks’ gestation. Population Women in British Columbia, Canada, who remained
pregnant ≥41+0 weeks and delivered at one of the province’s 42 hospitals with >50 annual deliveries, 2008–2012 (n = 14 627). Methods The proportion of women remaining pregnant a week or more past the expected delivery date who were induced at 41+0 or 41+1 weeks’ gestation for an indication of ‘post-dates’ was calculated for each institution. We used instrumental variable analysis (using the institutional rate of labour induction at 41+0 weeks as the instrument) to estimate the effect of labour induction on maternal and neonatal health outcomes. Main outcome measures Caesarean delivery, instrumental
delivery, post-partum haemorrhage, 3rd or 4th degree lacerations, macrosomia, neonatal intensive care unit admission, and 5-minute Apgar score
