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A randomized controlled trial of selective planned delivery
British Journal of Obstetrics and Gynaecology
|February 1, 1978
Summary
Selective planned delivery in normal pregnancies resulted in higher infant bilirubin levels but no treatment was needed. Mothers in the planned group required more pain relief, while controls had more meconium staining, with similar infant outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Neonatal Care
Background:
- Selective planned delivery is an alternative to expectant management for term pregnancies.
- Investigating the impact of planned delivery on maternal and neonatal outcomes is crucial for clinical practice.
Purpose of the Study:
- To compare maternal and neonatal outcomes between selective planned delivery and expectant management in term pregnancies.
- To assess the safety and efficacy of planned delivery in obstetrically normal women.
Main Methods:
- Prospective randomized controlled trial involving 264 women at 38 weeks gestation.
- Comparison of outcomes including infant serum bilirubin, maternal pethidine use, meconium staining, and Apgar scores.
- Follow-up to assess neonatal hyperbilirubinemia and stillbirth incidence.
Main Results:
- Infants in the planned delivery group had higher day 5 serum bilirubin levels, but none required treatment.
- Mothers in the planned delivery group used significantly more pethidine.
- Control group had a higher incidence of meconium staining; one stillbirth occurred in the control group due to fetal hypoxia.
- Infant Apgar scores were similar between groups.
Conclusions:
- Selective planned delivery in normal term pregnancies may lead to transient, non-critical hyperbilirubinemia in neonates.
- Planned delivery is associated with increased maternal analgesic requirements and a higher rate of meconium staining.
- While Apgar scores are similar, careful monitoring for fetal hypoxia is essential, particularly with induced labor for postmaturity.