Late term pregnancy Clinical outcomes and women’s perspectives

This thesis focuses on clinical outcomes and perspectives of women with uncomplicated pregnancies after allocation to a policy of induction of labour at 41 weeks or expectant management until 42 weeks. In a large multicenter trial a small though significant difference in the risk of adverse perinatal outcomes was found in favour of induction at 41 weeks compared to expectant management until 42 weeks. The incidence of perinatal mortality, Apgar score <4 at five minutes and NICU admission was low after both management strategies. An individual participant meta-analysis of trials comparing a policy of labour induction at 41 weeks with expectant management until 42 weeks showed similar results, but only for nulliparous women, not for multiparous women. Women participating in the trial had an overall good birth experience, both after induction at 41 weeks and expectant management until 42 weeks. Maternal anxiety is associated with a less positive birth experience, with the association stronger after caesarean section. Women vary in their preference for either induction at 41 weeks or expectant management, as well as in their motivation for this preference. Preference is influenced by anxiety, quality of life problems, the presence or absence of a wish for natural birth and a variety of additional reasons. Women with pregnancies approaching 41 weeks should be informed on the management options in late term pregnancies using absolute risks according to parity, so they can make an informed choice for one of the policies, in line with their own values and preference.