TY - JOUR
T1 - Which intrauterine growth restricted fetuses at term benefit from early labour induction? A secondary analysis of the DIGITAT randomised trial
AU - Tajik, Parvin
AU - van Wyk, Linda
AU - Boers, Kim E.
AU - le Cessie, Saskia
AU - Zafarmand, Mohammad Hadi
AU - Roumen, Frans
AU - van der Post, Joris A. M.
AU - Porath, Martina
AU - van Pampus, Maria G.
AU - Spaanderdami, Marc E. A.
AU - Kwee, Anneke
AU - Duvekot, Johannes J.
AU - Bremer, Henk A.
AU - Delemarre, Friso M. C.
AU - Bloemenkamp, Kitty W. M.
AU - de Groot, Christianne J. M.
AU - Willekes, Christine
AU - van Lith, Jan M. M.
AU - Bossuyt, Patrick M.
AU - Mol, Ben W. J.
AU - Scherjon, Sicco A.
AU - DIGITAT Study Grp
PY - 2014/1
Y1 - 2014/1
N2 - 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 scoreResults: 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. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
AB - 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 scoreResults: 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. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
KW - Intrauterine growth restriction (IUGR)
KW - Labour induction
KW - Expectant monitoring
KW - Treatment selection markers
KW - FETAL WEIGHT
KW - ULTRASOUND
KW - PRETERM
U2 - 10.1016/j.ejogrb.2013.10.014
DO - 10.1016/j.ejogrb.2013.10.014
M3 - Article
SN - 0301-2115
VL - 172
SP - 20
EP - 25
JO - European journal of obstetrics gynecology and reproductive biology
JF - European journal of obstetrics gynecology and reproductive biology
ER -