Doctors beginning to realize that induction is a big mistake

The wall is beginning to crack.  More and more evidence is piling up that all the inductions in the past 20 years for bogus reasons (like oligohydramnios, pregnancy of 41 weeks and gestational diabetes) have harmed women and babies.  Of course, the obstetricians would never apologize for this bloodbath.  Here’s the latest “study of the studies”–keep in mind that even the biggest, most carefully done studies are suspect in their methodology but, at least this one firmly denounces a number of the favourite reasons for inducing.  Gloria

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Indications for induction of labour: a best-evidence review

  E Mozurkewich, J Chilimigras, E Koepke, K Keeton, VJ King, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA Correspondence: Dr E Mozurkewich, F4835, PO Box 0264, Mott Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0264, USA.

Email mozurk@umich.edu

 Accepted 2 November 2008. Published Online 4 February 2009.

 Background:  Rates of labour induction are increasing.

 Objectives: To review the evidence supporting indications for induction.

 Search strategy: We listed indications for labour induction and then reviewed the evidence. We searched MEDLINE and the Cochrane Library between 1980 and April 2008 using several terms and combinations, including induction of labour, premature rupture of membranes, post-term pregnancy, preterm prelabour rupture of membranes (PROM), multiple gestation, suspected macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, fetal anomalies, systemic lupus erythematosis, oligohydramnios, alloimmunization, rhesus disease, intrahepatic cholestasis of pregnancy (IHCP), and intrauterine growth restriction (IUGR). We performed a review of the literature supporting each indication.

Selection criteria: We identified 1387 abstracts and reviewed 418 full text articles. We preferentially included high-quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised trials and observational studies.

Main results: We included 34 full text articles. For each indication, we assigned levels of evidence and grades of recommendation based upon the GRADE system. Recommendations for induction of labour for post-term gestation, PROM at term, and premature rupture of membranes near term with pulmonary maturity are supported by the evidence. Induction for IUGR before term reduces intrauterine fetal death, but increases caesarean deliveries and neonatal deaths.

Evidence is insufficient to support induction for women with insulin-requiring diabetes, twin gestation, fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease and fetal gastroschisis.

Authors’ conclusions: Research is needed to determine risks and benefits of induction for many commonly advocated clinical indications.

Keywords: Best evidence, indications, induction.

Please cite this paper as: Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King V. Indications for induction of labour: a best-evidence review. BJOG 2009;116:626-636

 

 http://www.ncbi.nlm.nih.gov/pubmed/19191776

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