Summary of findings 2. Labour induction versus expectant management (maternal outcomes).
Induction of labour for improving birth outcomes for women at or beyond term | ||||||
Population: pregnant women at or beyond 37 weeks gestation Setting: Austria, Canada, China, Finland, France, India, Malaysia, Netherlands, Norway, Spain, Sweden, Russia, Thailand, Tunisia, Turkey, UK, and USA Intervention: labour induction Comparison: expectant management | ||||||
Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Quality of the evidence (GRADE) | Comments | |
Risk with expectant management | Risk with labour induction | |||||
Caesarean section | Study population | RR 0.90 (0.85 to 0.95) | 21,030 (31 RCTs) | ⊕⊕⊕⊝ MODERATE1 | ||
186 per 1000 | 167 per 1000 (158 to 177) | |||||
Operative vaginal birth (forceps or ventouse) | Study population | RR 1.03 (0.96 to 1.10) | 18,584 (22 RCTs) | ⊕⊕⊕⊝ MODERATE1 | ||
136 per 1000 | 140 per 1000 (131 to 150) | |||||
Perineal trauma (severe perineal tear) | Study population | RR 1.04 (0.85 to 1.26) | 11,589 (5 RCTs) | ⊕⊕⊝⊝ LOW1,2 | ||
31 per 1000 | 33 per 1000 (26 to 39) | |||||
Postpartum haemorrhage | Study population | RR 1.02 (0.91 to 1.15) | 12,609 (9 RCTs) | ⊕⊕⊕⊝ MODERATE3 | variously defined | |
79 per 1000 | 81 per 1000 (73 to 91) | |||||
Breastfeeding at discharge | Study population | RR 1.00 (0.96 to 1.04) |
7487 (2 RCTs) |
⊕⊕⊕⊝ MODERATE4 | ||
505 per 1000 | 505 per 1000 (485 to 525) |
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Postnatal depression | Study population | ‐ | (0 RCTs) | ‐ | No RCTs reported data for this outcome. | |
see comment | see comment | |||||
Length of maternal hospital stay (days) | ‐ | ‐ | Average MD 0.19 days shorter for women who were induced (0.56 days shorter to 0.18 days longer) | 4120 (7 RCTs) | ⊕⊝⊝⊝ VERY LOW5 |
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*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio | ||||||
GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect |
1Downgraded 1 level for serious concerns regarding unclear allocation concealment methods for many of the 31 trials included for this outcome. 2Downgraded 1 level for serious concerns regarding imprecision with wde confidence intervals crossing the line of no effect, signalling some uncertainty about direction of effect.
3Downgraded 1 level for serious concerns regarding indirectness with postpartum haemorrhage defined in different ways for several of the trials.
4Downgraded 1 level for indirectness with one of the two studies reporting breastfeeding 4‐8 weeks after discharge (not at discharge).
5Downgraded 1 level for serious concerns regarding selection bias, with 4 of 5 trials having with unclear allocation concealment; and downgraded 2 levels for very serious concerns regarding inconsistency, with very high statistical heterogeneity (I² = 94%).