Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT

Kim E. Boers; Linda van Wyk; Joris A. M. van der Post; Anneke Kwee; Maria G. van Pampus; Marc E. A. Spaanderdam; Johannes J. Duvekot; Henk A. Bremer; Friso M. C. Delemarre; Kitty W. M. Bloemenkamp; Christianne J. M. de Groot; Christine Willekes; Monique Rijken; Frans J. M. E. Roumen; Jim G. Thornton; Jan M. M. van Lith; Ben W. J. Mol; Saskia le Cessie; Sicco A. Scherjon

doi:10.1016/j.ajog.2012.01.015

Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT

Kim E. Boers^*, Linda van Wyk, Joris A. M. van der Post, Anneke Kwee, Maria G. van Pampus, Marc E. A. Spaanderdam, Johannes J. Duvekot, Henk A. Bremer, Friso M. C. Delemarre, Kitty W. M. Bloemenkamp, Christianne J. M. de Groot, Christine Willekes, Monique Rijken, Frans J. M. E. Roumen, Jim G. Thornton, Jan M. M. van Lith, Ben W. J. Mol, Saskia le Cessie, Sicco A. Scherjon

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVE: The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) compared induction of labor and expectant management in suspected intrauterine growth restriction (IUGR) at term. In this subanalysis, we report neonatal morbidity between the policies based on the Morbidity Assessment Index for Newborns (MAIN). STUDY DESIGN: We used data from the DIGITAT. For each neonate, we calculated the MAIN score, a validated outcome scale. RESULTS: There were no differences in mean MAIN scores or in MAIN morbidity categories. We found that neonatal admissions are lower after 38 weeks' gestational age compared with 36 and 37 weeks in both groups. CONCLUSION: The incidence of neonatal morbidity in IUGR at term is comparable and relatively mild either after induction or after an expectant policy. However, neonatal admissions are lower after 38 weeks of pregnancy, so if induction to preempt possible stillbirth is considered, it is reasonable to delay until 38 weeks, provided watchful monitoring.

Original language	English
Pages (from-to)	344
Journal	American Journal of Obstetrics and Gynecology
Volume	206
Issue number	4
DOIs	https://doi.org/10.1016/j.ajog.2012.01.015
Publication status	Published - Apr 2012

Keywords

Disproportionate Intrauterine Growth Intervention Trial at Term
induction of labor
intrauterine growth restriction at term
Morbidity Assessment Index for Newborns score
neonatal morbidity

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Boers, K. E., van Wyk, L., van der Post, J. A. M., Kwee, A., van Pampus, M. G., Spaanderdam, M. E. A., Duvekot, J. J., Bremer, H. A., Delemarre, F. M. C., Bloemenkamp, K. W. M., de Groot, C. J. M., Willekes, C., Rijken, M., Roumen, F. J. M. E., Thornton, J. G., van Lith, J. M. M., Mol, B. W. J., le Cessie, S., & Scherjon, S. A. (2012). Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT. American Journal of Obstetrics and Gynecology, 206(4), 344. https://doi.org/10.1016/j.ajog.2012.01.015

@article{5bc841cfac974c569fdc8965dc8f8f95,

title = "Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT",

abstract = "OBJECTIVE: The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) compared induction of labor and expectant management in suspected intrauterine growth restriction (IUGR) at term. In this subanalysis, we report neonatal morbidity between the policies based on the Morbidity Assessment Index for Newborns (MAIN). STUDY DESIGN: We used data from the DIGITAT. For each neonate, we calculated the MAIN score, a validated outcome scale. RESULTS: There were no differences in mean MAIN scores or in MAIN morbidity categories. We found that neonatal admissions are lower after 38 weeks' gestational age compared with 36 and 37 weeks in both groups. CONCLUSION: The incidence of neonatal morbidity in IUGR at term is comparable and relatively mild either after induction or after an expectant policy. However, neonatal admissions are lower after 38 weeks of pregnancy, so if induction to preempt possible stillbirth is considered, it is reasonable to delay until 38 weeks, provided watchful monitoring.",

keywords = "Disproportionate Intrauterine Growth Intervention Trial at Term, induction of labor, intrauterine growth restriction at term, Morbidity Assessment Index for Newborns score, neonatal morbidity",

author = "Boers, {Kim E.} and {van Wyk}, Linda and {van der Post}, {Joris A. M.} and Anneke Kwee and {van Pampus}, {Maria G.} and Spaanderdam, {Marc E. A.} and Duvekot, {Johannes J.} and Bremer, {Henk A.} and Delemarre, {Friso M. C.} and Bloemenkamp, {Kitty W. M.} and {de Groot}, {Christianne J. M.} and Christine Willekes and Monique Rijken and Roumen, {Frans J. M. E.} and Thornton, {Jim G.} and {van Lith}, {Jan M. M.} and Mol, {Ben W. J.} and {le Cessie}, Saskia and Scherjon, {Sicco A.}",

year = "2012",

month = apr,

doi = "10.1016/j.ajog.2012.01.015",

language = "English",

volume = "206",

pages = "344",

journal = "American Journal of Obstetrics and Gynecology",

issn = "0002-9378",

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Boers, KE, van Wyk, L, van der Post, JAM, Kwee, A, van Pampus, MG, Spaanderdam, MEA, Duvekot, JJ, Bremer, HA, Delemarre, FMC, Bloemenkamp, KWM, de Groot, CJM, Willekes, C, Rijken, M, Roumen, FJME, Thornton, JG, van Lith, JMM, Mol, BWJ, le Cessie, S & Scherjon, SA 2012, 'Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT', American Journal of Obstetrics and Gynecology, vol. 206, no. 4, pp. 344. https://doi.org/10.1016/j.ajog.2012.01.015

TY - JOUR

T1 - Neonatal morbidity after induction vs expectant monitoring in intrauterine growth restriction at term: a subanalysis of the DIGITAT RCT

AU - Boers, Kim E.

AU - van Wyk, Linda

AU - van der Post, Joris A. M.

AU - Kwee, Anneke

AU - van Pampus, Maria G.

AU - Spaanderdam, Marc E. A.

AU - Duvekot, Johannes J.

AU - Bremer, Henk A.

AU - Delemarre, Friso M. C.

AU - Bloemenkamp, Kitty W. M.

AU - de Groot, Christianne J. M.

AU - Willekes, Christine

AU - Rijken, Monique

AU - Roumen, Frans J. M. E.

AU - Thornton, Jim G.

AU - van Lith, Jan M. M.

AU - Mol, Ben W. J.

AU - le Cessie, Saskia

AU - Scherjon, Sicco A.

PY - 2012/4

Y1 - 2012/4

N2 - OBJECTIVE: The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) compared induction of labor and expectant management in suspected intrauterine growth restriction (IUGR) at term. In this subanalysis, we report neonatal morbidity between the policies based on the Morbidity Assessment Index for Newborns (MAIN). STUDY DESIGN: We used data from the DIGITAT. For each neonate, we calculated the MAIN score, a validated outcome scale. RESULTS: There were no differences in mean MAIN scores or in MAIN morbidity categories. We found that neonatal admissions are lower after 38 weeks' gestational age compared with 36 and 37 weeks in both groups. CONCLUSION: The incidence of neonatal morbidity in IUGR at term is comparable and relatively mild either after induction or after an expectant policy. However, neonatal admissions are lower after 38 weeks of pregnancy, so if induction to preempt possible stillbirth is considered, it is reasonable to delay until 38 weeks, provided watchful monitoring.

AB - OBJECTIVE: The Disproportionate Intrauterine Growth Intervention Trial at Term (DIGITAT) compared induction of labor and expectant management in suspected intrauterine growth restriction (IUGR) at term. In this subanalysis, we report neonatal morbidity between the policies based on the Morbidity Assessment Index for Newborns (MAIN). STUDY DESIGN: We used data from the DIGITAT. For each neonate, we calculated the MAIN score, a validated outcome scale. RESULTS: There were no differences in mean MAIN scores or in MAIN morbidity categories. We found that neonatal admissions are lower after 38 weeks' gestational age compared with 36 and 37 weeks in both groups. CONCLUSION: The incidence of neonatal morbidity in IUGR at term is comparable and relatively mild either after induction or after an expectant policy. However, neonatal admissions are lower after 38 weeks of pregnancy, so if induction to preempt possible stillbirth is considered, it is reasonable to delay until 38 weeks, provided watchful monitoring.

KW - Disproportionate Intrauterine Growth Intervention Trial at Term

KW - induction of labor

KW - intrauterine growth restriction at term

KW - Morbidity Assessment Index for Newborns score

KW - neonatal morbidity

U2 - 10.1016/j.ajog.2012.01.015

DO - 10.1016/j.ajog.2012.01.015

M3 - Article

C2 - 22342897

SN - 0002-9378

VL - 206

SP - 344

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

IS - 4

ER -