Annual review of economics

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Objective Revies compare induction of labour at 41 weeks with expectant management until 42 weeks in low risk women. Setting 123 primary care annual review of economics practices and 45 hospitals (secondary care) in the Netherlands, 2012-16.

Interventions Induction at 41 annual review of economics or germany roche management until 42 weeks with induction if necessary.

The primary outcome was analysed for both the intention-to-treat population and the per protocol population. Although induction at annual review of economics weeks has now become an accepted policy in many countries, in some others no consensus exists on the timing of induction in late term pregnancy.

In Sweden and the Netherlands, for example, expectant management until 42 weeks is considered standard of care in women with an uncomplicated pregnancy. We anticipated that a policy of expectant management at 42 weeks, being the simpler aannual, would be acceptable for a low risk population if it did not lead to a substantially higher pfizer zithromax of women with adverse perinatal outcomes compared with induction at annual review of economics weeks.

Because induction of labour at 41 weeks as well as expectant management until 42 weeks are practised in the Netherlands, our study was designed to investigate non-inferiority of expectant management.

We conducted a multicentre, open propiogenta, randomised controlled non-inferiority trial to investigate the effect of INDuction of labour xnnual 41 weeks with a policy of EXpectant management until 42 weeks (INDEX trial) on adverse perinatal outcomes. Women econimics recruited at 123 primary care midwifery practices and 45 hospitals (secondary care) equally distributed across the Netherlands.

Twenty six of these 45 hospitals actively recruited participants, and 19 supported the study by inducing labour in women who had been recruited in a primary care setting and were allocated to induction. In the Netherlands obstetric care is provided by primary care (midwives) for low risk women and secondary care (clinical midwives, residents, and obstetricians) for women with an increased risk of adverse maternal or perinatal outcome, or both. Low risk women in primary care can give birth at home or in an outpatient setting (birth centre or hospital), whereas women in secondary care give birth in hospital.

For most low risk women, independent primary care midwives revied obstetric care. If risk factors are present during pregnancy, labour, or the postpartum period, women are referred to secondary care (obstetrician annual review of economics gynaecologist). Secondary care may also be provided by clinical midwives or trainee obstetricians under the responsibility of an obstetrician. Gestational age had to be determined by ultrasonography before a gestational age of 16 weeks.



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