Maternal and Perinatal Outcomes of Expectant Management of Full-Term, Low-Risk, Nulliparous Patients

In Reply:

We thank Drs. Boutin and Joseph for their interest in our article in the February 2021 issue¹ and appreciate the opportunity to clarify our approach further. Although they advocate for an alternative approach to data analysis, such an approach answers a different question than we sought to answer. In fact, we performed the appropriate analyses for the study questions we specified. The objective was to estimate and compare specified outcomes of interest among low-risk nulliparous individuals who deliver within a given week of gestation (eg, of those who deliver at 40 completed weeks, what is the frequency of cesarean delivery, perinatal composite or medically indicated induction, and how does this differ from the frequency in those who deliver at 39 weeks). These data are useful to counsel nulliparous patients about their outcomes if delivery occurs at a specific gestational age. We believe this is the appropriate approach for this subpopulation undergoing expectant management.