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Which intrauterine growth restricted fetuses at term benefit from early labour induction? A secondary analysis of the DIGITAT randomised trial.

Eur J Obstet Gynecol Reprod Biol. 2014 Jan;172:20-5. doi: 10.1016/j.ejogrb.2013.10.014. Epub 2013 Oct 16.

Tajik P1, van Wyk L2, Boers KE3, le Cessie S4, Zafarmand MH5, Roumen F6, van der Post JA5, Porath M7, van Pampus MG8, Spaanderdam ME9, Kwee A10, Duvekot JJ11, Bremer HA12, Delemarre FM13, Bloemenkamp KW2, de Groot CJ14, Willekes C15, van Lith JM2, Bossuyt PM16, Mol BW17, Scherjon SA18; DIGITAT Study Group.
Author information 1Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: P.Tajik@amc.uva.nl.2Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.3Department of Obstetrics and Gynaecology, Bronovo Hospital, The Hague, The Netherlands.4Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands.5Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.6Department of Obstetrics and Gynaecology, Atrium Medical Centre, Heerlen, The Netherlands.7Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands.8Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.9Department of Obstetrics and Gynaecology, University Medical Centre St. Radboud, Nijmegen, The Netherlands.10Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.11Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands.12Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, The Netherlands.13Department of Obstetrics and Gynaecology, Elkerliek Hospital, Helmond, The Netherlands.14Department of Obstetrics and Gynaecology, VU Medical Centre, Amsterdam, The Netherlands.15Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands.16Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.17Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands.18Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
Eur J Obstet Gynecol Reprod Biol
ABSTRACT
OBJECTIVE: The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT trial) showed that in women with suspected intrauterine growth restriction (IUGR) at term, there were no substantial outcome differences between induction of labour and expectant monitoring. The objective of the present analysis is to evaluate whether maternal or fetal markers could identify IUGR fetuses who would benefit from early labour induction.STUDY DESIGN: The DIGITAT trial was a multicenter, parallel and open-label randomised controlled trial in women who had a singleton pregnancy beyond 36+0 weeks’ gestation with suspected IUGR (n=650). Women had been randomly allocated to either labour induction or expectant monitoring. The primary outcome was a composite measure of adverse neonatal outcome, defined as neonatal death before hospital discharge, Apgar score <7, umbilical artery pH <7.05, or admission to neonatal intensive care. Using logistic regression modelling, we investigated associations between outcome and 17 markers, maternal characteristics and fetal sonographic and Doppler velocimetry measurements, all collected at study entry.RESULTS: 17 (5.3%) infants in the induction group had an adverse neonatal outcome compared to 20 (6.1%) in the expectant monitoring group. The only potentially informative marker for inducing labour was maternal pre-pregnancy body mass index (BMI). Otherwise, we observed at best weak associations between a benefit from labour induction and maternal age, ethnicity, smoking, parity, pregnancy-induced hypertension or preeclampsia, Bishop score and gestational age, or fetal sonographic markers (gender, estimated fetal weight, body measurements, oligohydramnios, or umbilical artery pulsatility index and end diastolic flow).CONCLUSION: In late preterm and term pregnancies complicated by suspected intrauterine growth restriction, most of the known prognostic markers seem unlikely to be helpful in identifying women who could benefit from labour induction, except for maternal pre-pregnancy BMI.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Source: Elsevier Science
PMID:24192662 | http://www.ncbi.nlm.nih.gov/pubmed/24192662

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