2548295
Description
Mind Map by Danny Tucker, updated more than 1 year ago
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Created by Danny Tucker
almost 9 years ago
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Induction of labour vs expectant
management for LGA fetuses
- Induction of labour vs expectant management for large-for-date
fetuses: a RCT. Lancet Online 9 April 2015
- Results
- 409 IOL vs 411 expectant
- Baseline characteristics similar
- 10 days average
difference in
delivery date
- Baseline characteristics similar
- Mean BW 3831g IOL vs 4118g expectant
- 50% reduction in >4000g infants & 75% reduction in >4500 infants
- 50% reduction in >4000g infants & 75% reduction in >4500 infants
- Primary outcome measure
- 8 (2%) of IOL and 25 (6%) of
expectant management
- NNT = 25
- NNT = 25
- 8 (2%) of IOL and 25 (6%) of
expectant management
- Caesarean section/operative vaginal
delivery, PPH & 3rd degree tears: No significant
difference
- TTN, NICU admission no difference
- Phototherapy 13% IOL vs 7% expectant,
esp IOL<38/40
- Phototherapy 13% IOL vs 7% expectant,
esp IOL<38/40
- Individual outcomes
- Significant SD: 16 vs 5
(4% vs 1%)
- Delay of >60s: 10 vs 2
(2% vs 1%)
- Fracture: 8 vs 2
(2% vs 1%)
- Significant SD: 16 vs 5
(4% vs 1%)
- 409 IOL vs 411 expectant
- Results
- Background
- CS to prevent macrosomia-related
complications only for >4500g GDM & >5000g non-GDM
- Systematic review of IOL vs conservative Mx = no
difference in CS, but no reduction in morbidity
- Small sample size
- EFW>4000g & >=40/40, so lower benefit as
baby already big
- Small sample size
- CS to prevent macrosomia-related
complications only for >4500g GDM & >5000g non-GDM
- Study design
- 19 tertiary care hospitals in France, Switzerland & Belgium
- 2002-2009
- Single, macrosomic fetus,
cephalic, no CI to vaginal
delivery
- Sample size 500/500 for 80% power, 5% type
1 error & RR 0.33-0.5. Note study ended at
407/411 due to financial constraints
- 2002-2009
- 1:1 randomisation
- IOL 37-38+6 within 3d of randomisation
- Primary composite outcome: shoulder
dystocia, # clavicle or long bone, brachial
plexus injury, ICH or death
- SD = not resolved with
McRoberts/suprapubic
pressure
- Note: also included >60s
head-body interval
- But no reduction in benefit with IOL
when this outcome excluded from
analysis
- But no reduction in benefit with IOL
when this outcome excluded from
analysis
- Note: also included >60s
head-body interval
- SD = not resolved with
McRoberts/suprapubic
pressure
- Intention to
treat analysis
- Screening via clinically LGA
- Hadlock >95%ile
- 3500g at 36 weeks,
3700g at 37 weeks,
3900g at 38 weeks
- 3500g at 36 weeks,
3700g at 37 weeks,
3900g at 38 weeks
- Hadlock >95%ile
- 19 tertiary care hospitals in France, Switzerland & Belgium
- Mind map by
Danny Tucker
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