Breaking News
August 16, 2018 - Promoting HPV Vaccine Doesn’t Prompt Risky Sex by Teens: Study
August 16, 2018 - Treating Rheumatoid Arthritis: Search for a Cure
August 16, 2018 - Research shows in the long run, charcoal toothpaste likely won’t whiten teeth
August 16, 2018 - Seattle Children’s opens new clinic to provide convenient access to pediatric specialty care services
August 16, 2018 - Curious case of the lost contact lens
August 16, 2018 - GN Hearing unveils world’s first Premium-Plus hearing aid
August 16, 2018 - Parental life span linked with increased longevity and health in daughters
August 16, 2018 - Health leaders reveal ten most important medicines in NHS history
August 16, 2018 - Mobile health devices diagnose hidden heart condition in at-risk populations
August 16, 2018 - When it comes to shedding pounds, it pays to think big
August 16, 2018 - Liva Healthcare announces appointment of Thomas Cooke as clinical services manager in the UK
August 16, 2018 - New digital pharmacy aims to help people living with chronic care conditions
August 16, 2018 - Preventing ACL injuries in high school athletes
August 16, 2018 - Experts provide insight into novel concepts and approaches for stroke rehabilitation
August 16, 2018 - Scientists reverse congenital blindness in mouse model
August 16, 2018 - Study shows link between use of benzodiazepines and increased risk of Alzheimer’s disease
August 16, 2018 - Trial shows PARP inhibitor as novel treatment option for patients with advanced breast cancers
August 16, 2018 - Prenatal exposure to violence increases toddlers’ aggressive behavior to their mothers
August 16, 2018 - Can manipulating gut microbes improve cardiac function in patients with heart failure?
August 16, 2018 - Hearts of newborn piglets can completely heal after heart attacks
August 16, 2018 - Ablating the mutant p53 gene in mice with colorectal cancer inhibits tumor growth
August 16, 2018 - Higher BMI in people with prediabetes related to evening preference and lack of sufficient sleep
August 16, 2018 - Using peripheral nerve blocks to treat facial pain may produce long-term pain relief
August 16, 2018 - Neural stem cells are the key to tail regeneration
August 16, 2018 - Study compares genetic and neural contributions to ADHD in children with or without TBI
August 16, 2018 - Adding energy drinks to alcohol may exacerbate negative effects of binge drinking
August 16, 2018 - Eye Examination Can Help Detect Abuse in Children
August 16, 2018 - Know the Difference: Rheumatoid Arthritis or Osteoarthritis?
August 16, 2018 - From ‘sea of mutations,’ two possible cancer links rise to the surface
August 16, 2018 - Does medical school take too long?
August 16, 2018 - Brown University researchers reveal key physical properties of ‘giant’ cancer cells
August 16, 2018 - Regular resistance training improves exercise motivation
August 16, 2018 - Feds urge states to encourage cheaper plans off the exchanges
August 16, 2018 - Seven activities that prevent you from getting quality sleep during summer
August 16, 2018 - Five ways to tell if your baby is getting enough milk from breastfeeding
August 16, 2018 - From Pigs to Peacocks, What’s Up With Those ‘Emotional-Support Animals’?
August 16, 2018 - Breast cancers enlist the help of normal cells to help them spread and survive
August 16, 2018 - Engaging with “high-need” patients outside the clinic
August 16, 2018 - Research illuminates how online forum may offer suicide prevention support for males
August 16, 2018 - Researchers identify way to grow immune cells at large scale for preventing cancer reoccurrence
August 15, 2018 - Keck Medicine of USC’s hospitals ranked among nation’s best for the 10th consecutive year
August 15, 2018 - Researchers compare existing approaches for automating diagnostic procedures of skin lesions
August 15, 2018 - Autism risk determined by health of mom’s gut, research reveals
August 15, 2018 - WELL for Life challenges you to explore the great outdoors
August 15, 2018 - ‘Zombie’ gene protects elephants from cancer, study finds
August 15, 2018 - Ebola outbreak in Congo spreads to active combat zone
August 15, 2018 - Study highlights pollution exposure of babies in prams
August 15, 2018 - Study provides insight into link between sleep apnea and lipid metabolism
August 15, 2018 - New study focuses on promise of gene therapy for Amish nemaline myopathy
August 15, 2018 - Researchers discover new approach to alleviate chronic itch
August 15, 2018 - Uncovering the Mysteries of MS: Medical Imaging Helps NIH Researchers Understand the Tricky Disease
August 15, 2018 - Autistic people at greater risk of becoming homeless – new research
August 15, 2018 - New imaging technique can spot tuberculosis infection in an hour
August 15, 2018 - Scientists study effects of eating breakfast versus fasting overnight before exercise
August 15, 2018 - Talking with children about suicide could save lives
August 15, 2018 - Grip strength of children predicts future cardiometabolic health
August 15, 2018 - New polyclonal immunotherapy successfully neutralizes Ebola virus
August 15, 2018 - Innovative oncofertility program launched by RMA of New York and Mount Sinai Health System
August 15, 2018 - Study shows efficacy, safety of AAV5-based gene therapy to treat sheep model of achromatopsia
August 15, 2018 - Simple score helps predict which hospitalized heart attack patients are at high risk of readmissions
August 15, 2018 - New discoveries show how protein droplets do more than keep cells’ interiors tidy
August 15, 2018 - Study shows impact of optimizing airport flight patterns on human health
August 15, 2018 - Life experiences of feeling unwanted or unplanned associated with attachment insecurity
August 15, 2018 - ACS Briefing Discusses Use of Lessons From Combat Care
August 15, 2018 - Study identifies distinct origin of ADHD in children with history of brain injury
August 15, 2018 - IgG3 antibody stops B cells from fighting pathogens in HIV patients
August 15, 2018 - Scientists discover key vulnerability of mixed lineage leukemia
August 15, 2018 - College students may experience pressures from secondary exposure to opioid abuse
August 15, 2018 - Powerful new microscope reveals inner workings of human cells with unprecedented clarity
August 15, 2018 - Married people who fight nastily more likely to suffer from leaky guts, study suggests
August 15, 2018 - Working Out After Baby – Drugs.com MedNews
August 15, 2018 - Rheumatoid Factor (RF) Test: MedlinePlus Lab Test Information
August 15, 2018 - ADHD linked to an increased risk of injury in children, study finds
August 15, 2018 - UIC researchers receive NIH funding to develop a better way to regenerate bone or tissues
August 15, 2018 - Study reveals how immune cells in the brain influence sexual behavior
August 15, 2018 - Researchers move closer to finding potential soft spot in drug-resistant tuberculosis
August 15, 2018 - Real-time dynamic monitoring of cell’s nucleus for effective cancer screening
August 15, 2018 - Lower rates of Medicare preventive care visits found in racial, ethnic minority older adults
August 15, 2018 - Scientists identify stress hormone as key factor in failure of immune system to inhibit leukemia
August 15, 2018 - Cytoplan introduces three new nutritional supplements
Electing to induce labor at 39 weeks reduces the need for C-section

Electing to induce labor at 39 weeks reduces the need for C-section

image_pdfDownload PDFimage_print

Inducing labor in healthy women at 39 weeks into their pregnancy reduces the need for cesarean section and is at least as safe for mother and baby as waiting for spontaneous labor. Choosing to induce could also reduce the risk that mothers will develop preeclampsia and that newborns will need respiratory support after delivery, according to a study publishing online in the New England Journal of Medicine on August 8.

“This doesn’t mean that everyone should be induced at 39 weeks,” says the study’s co-author Robert Silver, M.D., chair of Obstetrics & Gynecology at University of Utah Health and a Maternal-Fetal Medicine physician at Intermountain Healthcare in Salt Lake City. Kim Hall, R.N., B.S.N., a research nurse coordinator at U of U Health and Intermountain Healthcare also a co-author on the study.

“Electing to induce labor is a reasonable option that may give the best chance for vaginal delivery and improve outcomes,” says Silver.

Results were from 6,106 first-time mothers enrolled into the randomized ARRIVE clinical trial carried out at 41 hospitals participating in the National Institutes of Health-supported Maternal Fetal Medicine Units Network. More than 1,200 women were at the Utah MFMUN, consisting of University Hospital and Intermountain Medical Center, the largest enrolling site in the trial.

A Rising C-Section Rate

Driving the study is a steadily increasing rate of babies being delivered by C-section in the U.S., a number that has been holding at 32 percent since 2016. Medically unnecessary cesarean deliveries in healthy first-time mothers account for 80 percent of those deliveries, a point of concern.

Although the procedure is generally safe, the major surgery increases risk for complications to both mother and baby, and to future pregnancies. Women who deliver by C-section once are more likely to continue delivering that way, increasing the likelihood of high-risk complications such as placenta accreta.

For years, health care providers had been taught to avoid inducing labor in healthy, first-time mothers based on the belief that inducing increases the chance for C-section births. However, recent results from small, observational studies indicated that this may not necessarily be the case.

ARRIVE was a prospective trial designed to test this premise by examining outcomes from two groups of healthy, first-time mothers. One group elected to induce labor at 39 weeks, when the baby is full term and it is considered safe for mothers to give birth. The other group took part in expectant management or “watchful waiting,” the routine practice of waiting for spontaneous labor but undergoing active intervention should a medical need arise.

Inducing Labor vs. Waiting

On average, women who chose to induce at 39 weeks delivered nearly one week earlier than women who waited for spontaneous labor. C-section delivery was significantly less likely after elective induction than after expectant management (18.6 vs. 22.2 percent).

Based on these data, the researchers estimate that inducing labor at 39 weeks could eliminate the need for 1 C-section for every 28 deliveries.

“We’re always trying to find the safest way to deliver babies and take care of our patients,” says M. Sean Esplin, M.D., an associate professor of Obstetrics and Gynecology at U of U Health and chief of Maternal-Fetal Medicine at Intermountain Healthcare. “If the primary goal is to keep rates of C-sections down, then elective induction is an option.”

Choosing to induce labor at 39 weeks is at least as safe as spontaneous labor, according to results from the study. A composite score measuring several health indicators in newborns -; including death, seizures, hemorrhage and trauma -; was not significantly different between the two groups.

Inducing labor was linked to significant improvement in two specific outcomes: women were less likely to develop preeclampsia (9 vs. 14 percent), and rates of respiratory distress decreased in newborns. Silver says that the placenta tends not to function as well later in pregnancy, possibly explaining why mothers and babies who deliver earlier may fare better.

The study’s findings held true regardless of the woman’s age, ethnicity and BMI. Currently, researchers are evaluating whether inducing delivery at 39 weeks is cost effective.

“These results open the door for pregnant women and their health care providers to talk about what the woman wants to do,” says Michael Varner, M.D., vice chair for research in Obstetrics and Gynecology at U of U Health and primary investigator of the Utah MFMUN.

“The opinions that matter most comes from the women we serve,” says Varner.

Source:

http://uofuhealth.utah.edu/

Tagged with:

About author

Related Articles