Induction of Labour in Low-Risk Pregnancies before 40 Weeks of Gestation: A Systematic Review and Meta-Analysis [11P]
Bibliographic record
Abstract
INTRODUCTION: Retrospective data suggest that adverse outcomes in low-risk pregnancies are lowest at 39 weeks, and systematic reviews of randomized controlled trials (RCTs) suggests that induction of labour (IOL) after 37 weeks regardless of indication and cervical favourability is associated with lower rates of caesarean deliveries (CD) when compared with expectant management. Our objective was to determine whether IOL <40 weeks reduces CD rates and improves pregnancy outcomes. METHODS: We conducted a systematic review of RCTs comparing IOL to expectant management in low-risk women. We searched four databases until November 2016 using appropriate keywords and MeSH terms. Two authors independently completed title screening, data extraction and risk-of-bias (ROB) assessment using the Cochrane ROB tool. Meta-analysis was performed using RevMan 5.3 and results were reported as odds ratios and 95% confidence intervals (OR, 95%CI). RESULTS: We identified 2523 titles and included 14 eligible articles, most of which had low ROB. Outcomes for IOL (n=1268) vs. expectant management (n=1266) were as follows: CD 1.02 (0.81, 1.28), operative vaginal delivery 1.32 (1.06, 1.66), infective morbidity 1.26 (0.79, 1.99), perinatal mortality 0.72 (0.14, 3.71), postpartum 1.00 (0.73, 1.38), neonatal admissions 0.71 (0.33, 1.51), abnormal cord gases 0.69 (0.26, 1.87) and low 5-minute Apgar scores 0.94 (0.44, 2.03). CONCLUSION: There were no differences in rates of CD or other adverse pregnancy outcomes when IOL <40 weeks is compared with expectant management in low-risk pregnancies. A policy of IOL at 39 weeks to lower CD rates and improve pregnancy outcomes can only be recommended under the confines of RCTs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.047 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.037 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".