- Author
-
J.K.J. Keulen
- Title
- Late term pregnancy
- Subtitle
- Clinical outcomes and women’s perspectives
- Supervisors
-
J.A.M. van der Post
B.W.J. Mol - Co-supervisors
-
E.R. de Miranda
J. van Dillen - Award date
- 25 June 2021
- Number of pages
- 187
- ISBN
- 9789464192155
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
This thesis focuses on clinical outcomes and perspectives of women with uncomplicated pregnancies after allocation to a policy of induction of labour at 41 weeks or expectant management until 42 weeks. In a large multicenter trial a small though significant difference in the risk of adverse perinatal outcomes was found in favour of induction at 41 weeks compared to expectant management until 42 weeks. The incidence of perinatal mortality, Apgar score <4 at five minutes and NICU admission was low after both management strategies. An individual participant meta-analysis of trials comparing a policy of labour induction at 41 weeks with expectant management until 42 weeks showed similar results, but only for nulliparous women, not for multiparous women. Women participating in the trial had an overall good birth experience, both after induction at 41 weeks and expectant management until 42 weeks. Maternal anxiety is associated with a less positive birth experience, with the association stronger after caesarean section. Women vary in their preference for either induction at 41 weeks or expectant management, as well as in their motivation for this preference. Preference is influenced by anxiety, quality of life problems, the presence or absence of a wish for natural birth and a variety of additional reasons. Women with pregnancies approaching 41 weeks should be informed on the management options in late term pregnancies using absolute risks according to parity, so they can make an informed choice for one of the policies, in line with their own values and preference.
- Other links
- Chapter 2 (original article)
Chapter 5 (original article) - Persistent Identifier
- https://hdl.handle.net/11245.1/fdabaa85-36a0-4cae-af3f-c8611cccd8c8
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction
Chapter 2: Timing induction of labour at 41 or 42 weeks? A closer look at time frames of comparison: A review
Chapter 3: Induction of labour at 41 weeks versus expectant management until 42 weeks (INDEX): Multicentre, randomised non-inferiority trial
Chapter 4: Induction of labour at 41 weeks or expectant management until 42 weeks: A systematic review and an individual participant data meta-analysis of randomised trials
Chapter 5: What women want and why: Women’s preferences for induction of labour or expectant management in late-term pregnancy
Chapter 6: Women’s experiences and preferences after randomisation to elective induction of labour at 41 weeks or a policy of expectant management until 42 weeks
Chapter 7: General discussion and future perspectives
Chapter 8: Summary
Chapter 9: Summary in Dutch (Samenvatting in het Nederlands)
Abbreviations; Authors and affiliations; Portfolio; Publications; Acknowledgements (Dankwoord); Curriculum vitae
- Supplementary materials
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