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4. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development – the 2Close study: a multicentre randomised controlled trial

Author

Stegwee, S. I., Jordans, I. P. M., van der Voet, L. F., Bongers, M. Y., de Groot, C. J. M., Lambalk, C. B., de Leeuw, R. A., Hehenkamp, W. J. K., van de Ven, P. M., Bosmans, J. E., Pajkrt, E., Bakkum, E. A., Radder, C. M., Hemelaar, M., van Baal, W. M., Visser, H., van Laar, J. O. E. H., van Vliet, H. A. A. M., Rijnders, R. J. P., Sueters, M., Janssen, C. A. H., Hermes, W., Feitsma, A. H., Kapiteijn, K., Scheepers, H. C. J., Langenveld, J., de Boer, K., Coppus, S. F. P. J., Schippers, D. H., Oei, A. L. M., Kaplan, M., Papatsonis, D. N. M., de Vleeschouwer, L. H. M., van Beek, E., Bekker, M. N., Huisjes, A. J. M., Meijer, W. J., Deurloo, K. L., Boormans, E. M. A., van Eijndhoven, H. W. F., and Huirne, J. A. F.

Published
2019
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18. Effect of single- versus double-layer uterine closure during caesarean section on postmenstrual spotting (2Close): multicentre, double-blind, randomised controlled superiority trial

Author

Stegwee, S. I., van der Voet, L. F., Ben, A. J., de Leeuw, R. A., van de Ven, P. M., Duijnhoven, R. G., Bongers, M. Y., Lambalk, C. B., de Groot, C. J. M., Huirne, J. A. F., Papatsonis, Dimitri N. M., Pajkrt, Eva, Hehenkamp, Wouter J. K., Oei, Angèle L. M., Bekker, Mireille N., Schippers, Daniela H., van Vliet, Huib A. AM, van der Voet, Lucet, Schuitemaker, Nico W. E., Hemelaar, Majoie, van Baal, W. M., Huisjes, Anjoke J. M., Meijer, Wouter J., Janssen, C. A. H., Hermes, Wietske, Feitsma, A. H., van Eijndhoven, Hugo W. F., Rijnders, Robbert J. P., Sueters, Marieke, Scheepers, H. C. J., van Laar, Judith O. EH, Boormans, Elisabeth M. A., van Kesteren, Paul J. M., Radder, Celine M., Hink, Esther, Kapiteijn, Kitty, de Boer, Karin, Kaplan, Mesrure, van Beek, Erik, de Vleeschouwer, L. H. M., Visser, Harry, Bosmans, Judith E., el Alili, Mohamed, Langenveld, Josje, RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Health Economics and Health Technology Assessment, Amsterdam Public Health, Science and Society, APH - Mental Health, APH - Methodology, Obstetrics and Gynaecology, APH - Personalized Medicine, APH - Quality of Care, ARD - Amsterdam Reproduction and Development, Obstetrics and gynaecology, Amsterdam Reproduction & Development (AR&D), Epidemiology and Data Science, ACS - Heart failure & arrhythmias, APH - Societal Participation & Health, Other Research, and Cardiology

Subjects
SYMPTOMS, medicine.medical_treatment, CORONIS, Postoperative Complications, 0302 clinical medicine, Superiority Trial, Pregnancy, uterine closure technique, Medicine and Health Sciences, Caesarean section, Menstruation Disturbances, media_common, education.field_of_study, OUTCOMES, 030219 obstetrics & reproductive medicine, Obstetrics, NICHE, Obstetrics and Gynecology, PREVALENCE, Treatment Outcome, Female, Adult, medicine.medical_specialty, INCISION, media_common.quotation_subject, Population, TERM, Postmenstrual spotting, Double blind, 03 medical and health sciences, single layer, Double-Blind Method, medicine, Humans, Closure (psychology), education, Menstrual cycle, Cesarean Section, business.industry, Suture Techniques, Perioperative, SCAR, FACTORIAL, Linear Models, RISK-FACTORS, double layer, postmenstrual spotting, business, Follow-Up Studies
Abstract

Objective To evaluate whether double-layer uterine closure after a first caesarean section (CS) is superior compared with single-layer uterine closure in terms of postmenstrual spotting and niche development in the uterine caesarean scar.Design Multicentre, double-blind, randomised controlled superiority trial.Setting Thirty-two hospitals in the Netherlands.Population A total of 2292 women aged >= 18 years undergoing a first CS were randomly assigned to each procedure (1:1): 1144 women were assigned to single-layer uterine closure and 1148 women were assigned to double-layer uterine closure.Methods Single-layer unlocked closure and double-layer unlocked closure, with the second layer imbricating the first.Main outcome measures Number of days with postmenstrual spotting during one menstrual cycle 9 months after CS. Secondary outcomes: perioperative and menstrual characteristics; transvaginal ultrasound measurements.Results A total of 774 (67.7%) women from the single-layer group and 770 (67.1%) women from the double-layer group were evaluable for the primary outcome, as a result of drop-out and amenorrhoea. The mean number of postmenstrual spotting days was 1.33 (bootstrapped 95% CI 1.12-1.54) after single-layer closure and 1.26 (bootstrapped 95% CI 1.07-1.45) after double-layer closure (adjusted mean difference -0.07, 95% CI -0.37 to 0.22, P = 0.810). The operative time was 3.9 minutes longer (95% CI 3.0-4.9 minutes, P < 0.001) and niche prevalence was 4.7% higher (95% CI 0.7-8.7%, P = 0.022) after double-layer closure.Conclusions The superiority of double-layer closure compared with single-layer closure in terms of postmenstrual spotting after a first CS was not shown. Long-term obstetric follow-up of our trial is needed to assess whether uterine caesarean closure guidelines should be adapted.Tweetable abstract Double-layer uterine closure is not superior for postmenstrual spotting after a first caesarean; single-layer closure performs slightly better on other outcomes.

Published
2021
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19. Renal and Bladder Cancer During Pregnancy: A Review of 47 Cases and Literature-based Recommendations for Management

Author

Maggen, C, Linssen, J, Gziri, M, Zola, P, Cardonick, E, de Groot, C, Garcia, A, Fruscio, R, Drochytek, V, Van Calsteren, K, Albersen, M, Amant, F, Maggen C., Linssen J., Gziri M. M., Zola P., Cardonick E., de Groot C. J. M., Garcia A. C., Fruscio R., Drochytek V., Van Calsteren K., Albersen M., Amant F., Maggen, C, Linssen, J, Gziri, M, Zola, P, Cardonick, E, de Groot, C, Garcia, A, Fruscio, R, Drochytek, V, Van Calsteren, K, Albersen, M, Amant, F, Maggen C., Linssen J., Gziri M. M., Zola P., Cardonick E., de Groot C. J. M., Garcia A. C., Fruscio R., Drochytek V., Van Calsteren K., Albersen M., and Amant F.

Abstract

Objective: To provide contemporary gestational age-specific recommendations for management, a retrospective series of patients with renal or bladder cancer during pregnancy is reported. Methods: Obstetric and oncological data of pregnant patients with a diagnosis of renal or bladder cancer were selected from the worldwide registry of the International Network of Cancer, Infertility and Pregnancy. In addition, the literature was reviewed for recent case reports since last reviews in 2014 for renal cancer and 2004 for bladder cancer. Results: International Network of Cancer, Infertility and Pregnancy registered 22 cases (14 renal cancer and 8 bladder cancer), diagnosed between 1999 and 2017, and the literature reported 15 cases with renal cancer and 10 cases with bladder cancer between 2004 and 2019. Most common symptoms for renal and bladder cancer were pain (28%) and hematuria (66%), respectively. In more than half of the patients, surgical treatment was performed during pregnancy. Preterm deliveries were mostly medically induced (12 of 17, 71%) and all patients with a planned delivery before 34 weeks had advanced cancer. For renal and bladder cancer respectively, 79% and 87% of patients obtained complete remission. Advanced cancer stages had worse prognosis; 3 of 7 patients with known follow-up deceased within 15 months after diagnosis. Conclusion: Gestational age at diagnosis determines further management of renal and bladder cancers during pregnancy. Advanced stages challenge decision-making. The maternal needs for immediate treatment, and the neonatal risks including the impact of a preterm delivery should be discussed in a multidisciplinary setting while respecting the patient's autonomy.

Published
2021

26. Feasibility study for performing uterus transplantation in the Netherlands

Author

Peters, H E, primary, Juffermans, L J M, primary, Lambalk, C B, primary, Dekker, J J M L, primary, Fernhout, T, primary, Groenman, F A, primary, de Groot, C J M, primary, Hoksbergen, A W J, primary, Huirne, J A F, primary, de Leeuw, R A, primary, van Mello, N M, primary, Nederhoed, J H, primary, Schats, R, primary, Verhoeven, M O, primary, and Hehenkamp, W J K, primary

Published
2020
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27. Liver failure after delivery

Author

de Groot, C J M, van Goor, G M, Stolk, M F, Metselaar, H J, Janssen, H L A, Kazemier, G, Zondervan, P E, and Wanless, I R

Published
2005

28. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development - the 2Close study: a multicentre randomised controlled trial

Author

Arts-assistenten Kinderen, Orthopaedie Opleiding, Regenerative Medicine and Stem Cells, MS Reumatologie/Immunologie/Infectie, Infection & Immunity, MS Verloskunde, Child Health, Arts-assistenten DV&B, Stegwee, S I, Jordans, I P M, van der Voet, L F, Bongers, M Y, de Groot, C J M, Lambalk, C B, de Leeuw, R A, Hehenkamp, W J K, van de Ven, P M, Bosmans, J E, Pajkrt, E, Bakkum, E A, Radder, C M, Hemelaar, M, van Baal, W M, Visser, H, van Laar, J O E H, van Vliet, H A A M, Rijnders, R J P, Sueters, M, Janssen, C A H, Hermes, W, Feitsma, A H, Kapiteijn, K, Scheepers, H C J, Langenveld, J, de Boer, K, Coppus, S F P J, Schippers, D H, Oei, A L M, Kaplan, M, Papatsonis, D N M, de Vleeschouwer, L H M, van Beek, E, Bekker, M N, Huisjes, A J M, Meijer, W J, Deurloo, K L, Boormans, E M A, van Eijndhoven, H W F, Huirne, J A F, Arts-assistenten Kinderen, Orthopaedie Opleiding, Regenerative Medicine and Stem Cells, MS Reumatologie/Immunologie/Infectie, Infection & Immunity, MS Verloskunde, Child Health, Arts-assistenten DV&B, Stegwee, S I, Jordans, I P M, van der Voet, L F, Bongers, M Y, de Groot, C J M, Lambalk, C B, de Leeuw, R A, Hehenkamp, W J K, van de Ven, P M, Bosmans, J E, Pajkrt, E, Bakkum, E A, Radder, C M, Hemelaar, M, van Baal, W M, Visser, H, van Laar, J O E H, van Vliet, H A A M, Rijnders, R J P, Sueters, M, Janssen, C A H, Hermes, W, Feitsma, A H, Kapiteijn, K, Scheepers, H C J, Langenveld, J, de Boer, K, Coppus, S F P J, Schippers, D H, Oei, A L M, Kaplan, M, Papatsonis, D N M, de Vleeschouwer, L H M, van Beek, E, Bekker, M N, Huisjes, A J M, Meijer, W J, Deurloo, K L, Boormans, E M A, van Eijndhoven, H W F, and Huirne, J A F

Published
2019

34. Influence of cut-off value on prevalence of short cervical length

Author

Epi Methoden Team 4, van Os, M. A., Kleinrouweler, C. E., Schuit, E., van der Ven, A. J., Pajkrt, E., de Groot, C. J M, Mol, B. W J, Haak, M. C., Epi Methoden Team 4, van Os, M. A., Kleinrouweler, C. E., Schuit, E., van der Ven, A. J., Pajkrt, E., de Groot, C. J M, Mol, B. W J, and Haak, M. C.

Published
2017

38. Outcome of Multifetal Pregnancy Reduction in Women with a Dichorionic Triamniotic Triplet Pregnancy to a Singleton Pregnancy : A Retrospective Nationwide Cohort Study

Author

Van De Mheen, L., Everwijn, S. M P, Haak, M. C., Manten, G. T R, Zondervan, H. A., Knapen, M. F C M, Engels, M. A J, Erwich, J. J H M, Coumans, A. B., Van Vugt, J. M G, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, Pajkrt, E., Van De Mheen, L., Everwijn, S. M P, Haak, M. C., Manten, G. T R, Zondervan, H. A., Knapen, M. F C M, Engels, M. A J, Erwich, J. J H M, Coumans, A. B., Van Vugt, J. M G, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, and Pajkrt, E.

Published
2016

39. Outcome of Multifetal Pregnancy Reduction in Women with a Dichorionic Triamniotic Triplet Pregnancy to a Singleton Pregnancy: A Retrospective Nationwide Cohort Study

Author

UMC Utrecht, MS Verloskunde, Other research (not in main researchprogram), Van De Mheen, L., Everwijn, S. M P, Haak, M. C., Manten, G. T R, Zondervan, H. A., Knapen, M. F C M, Engels, M. A J, Erwich, J. J H M, Coumans, A. B., Van Vugt, J. M G, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, Pajkrt, E., UMC Utrecht, MS Verloskunde, Other research (not in main researchprogram), Van De Mheen, L., Everwijn, S. M P, Haak, M. C., Manten, G. T R, Zondervan, H. A., Knapen, M. F C M, Engels, M. A J, Erwich, J. J H M, Coumans, A. B., Van Vugt, J. M G, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, and Pajkrt, E.

Published
2016

40. Pregnancy Outcome after Fetal Reduction in Women with a Dichorionic Twin Pregnancy

Author

Van De Mheen, L., Everwijn, S. M P, Knapen, M. F C M, Haak, M. C., Engels, M. A J, Manten, G. T R, Zondervan, H. A., Wirjosoekarto, S. A M, van Vugt, John M G, Erwich, J. J H M, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, Pajkrt, E., Van De Mheen, L., Everwijn, S. M P, Knapen, M. F C M, Haak, M. C., Engels, M. A J, Manten, G. T R, Zondervan, H. A., Wirjosoekarto, S. A M, van Vugt, John M G, Erwich, J. J H M, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, and Pajkrt, E.

Published
2015

41. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy

Author

van de Mheen, L, Everwijn, S M P, Knapen, M F C M, Haak, M C, Engels, M A J, Manten, G T R, Zondervan, H A, Wirjosoekarto, S A M, van Vugt, J M G, Erwich, J J H M, Bilardo, C M, van Pampus, M G, de Groot, C J M, Mol, B W J, Pajkrt, E, van de Mheen, L, Everwijn, S M P, Knapen, M F C M, Haak, M C, Engels, M A J, Manten, G T R, Zondervan, H A, Wirjosoekarto, S A M, van Vugt, J M G, Erwich, J J H M, Bilardo, C M, van Pampus, M G, de Groot, C J M, Mol, B W J, and Pajkrt, E

Published
2015

42. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

Author

van de Mheen, L, Schuit, E, Liem, S M S, Lim, A C, Bekedam, D J, Goossens, S M T A, Franssen, M T M, Porath, M M, Oudijk, M A, Bloemenkamp, K W M, Duvekot, J J, Woiski, M D, de Graaf, I, Sikkema, J M, Scheepers, H C J, van Eijk, J, de Groot, C J M, van Pampus, M G, Mol, B W J, van de Mheen, L, Schuit, E, Liem, S M S, Lim, A C, Bekedam, D J, Goossens, S M T A, Franssen, M T M, Porath, M M, Oudijk, M A, Bloemenkamp, K W M, Duvekot, J J, Woiski, M D, de Graaf, I, Sikkema, J M, Scheepers, H C J, van Eijk, J, de Groot, C J M, van Pampus, M G, and Mol, B W J

Published
2015

43. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy

Author

MS Verloskunde, Other research (not in main researchprogram), van de Mheen, L, Everwijn, S M P, Knapen, M F C M, Haak, M C, Engels, M A J, Manten, G T R, Zondervan, H A, Wirjosoekarto, S A M, van Vugt, J M G, Erwich, J J H M, Bilardo, C M, van Pampus, M G, de Groot, C J M, Mol, B W J, Pajkrt, E, MS Verloskunde, Other research (not in main researchprogram), van de Mheen, L, Everwijn, S M P, Knapen, M F C M, Haak, M C, Engels, M A J, Manten, G T R, Zondervan, H A, Wirjosoekarto, S A M, van Vugt, J M G, Erwich, J J H M, Bilardo, C M, van Pampus, M G, de Groot, C J M, Mol, B W J, and Pajkrt, E

Published
2015

44. Pregnancy Outcome after Fetal Reduction in Women with a Dichorionic Twin Pregnancy

Author

UMC Utrecht, MS Verloskunde, Other research (not in main researchprogram), Van De Mheen, L., Everwijn, S. M P, Knapen, M. F C M, Haak, M. C., Engels, M. A J, Manten, G. T R, Zondervan, H. A., Wirjosoekarto, S. A M, van Vugt, John M G, Erwich, J. J H M, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, Pajkrt, E., UMC Utrecht, MS Verloskunde, Other research (not in main researchprogram), Van De Mheen, L., Everwijn, S. M P, Knapen, M. F C M, Haak, M. C., Engels, M. A J, Manten, G. T R, Zondervan, H. A., Wirjosoekarto, S. A M, van Vugt, John M G, Erwich, J. J H M, Bilardo, C. M., Van Pampus, M. G., De Groot, C. J M, Mol, B. W J, and Pajkrt, E.

Published
2015

45. Second-trimester cervical length as risk indicator for Cesarean delivery in women with twin pregnancy

Author

Epi Methoden Team 1, Other research (not in main researchprogram), Geboortecentrum voorzitterschap, van de Mheen, L, Schuit, E, Liem, S M S, Lim, A C, Bekedam, D J, Goossens, S M T A, Franssen, M T M, Porath, M M, Oudijk, M A, Bloemenkamp, K W M, Duvekot, J J, Woiski, M D, de Graaf, I, Sikkema, J M, Scheepers, H C J, van Eijk, J, de Groot, C J M, van Pampus, M G, Mol, B W J, Epi Methoden Team 1, Other research (not in main researchprogram), Geboortecentrum voorzitterschap, van de Mheen, L, Schuit, E, Liem, S M S, Lim, A C, Bekedam, D J, Goossens, S M T A, Franssen, M T M, Porath, M M, Oudijk, M A, Bloemenkamp, K W M, Duvekot, J J, Woiski, M D, de Graaf, I, Sikkema, J M, Scheepers, H C J, van Eijk, J, de Groot, C J M, van Pampus, M G, and Mol, B W J

Published
2015

46. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis.

Author

Stegwee, S. I., Jordans, I. P. M., van der Voet, L. F., van de Ven, P. M., Ket, J. C. F., Lambalk, C. B., de Groot, C. J. M., Hehenkamp, W. J. K., Huirne, J. A. F., Jordans, Ipm, Ket, Jcf, de Groot, Cjm, Hehenkamp, Wjk, and Huirne, Jaf

Subjects
CESAREAN section complications, UTERINE surgery, HEALTH outcome assessment, RANDOMIZED controlled trials, SYSTEMATIC reviews, CESAREAN section, CLINICAL trials, DYSMENORRHEA, LONGITUDINAL method, META-analysis, MYOMETRIUM, SURGICAL complications, OPERATIVE surgery, SUTURING, ULTRASONIC imaging, UTERUS, UTERINE rupture, WOUND healing, TREATMENT effectiveness
Abstract

Background: Caesarean section (CS) rates are rising globally. Long-term adverse outcomes after CS might be reduced when the optimal uterine closure technique becomes evident.Objective: To determine the effect of uterine closure techniques after CS on maternal and ultrasound outcomes.Search Strategy: Literature search in electronic databases.Selection Criteria: Randomised controlled trials (RCTs) or prospective cohort studies that evaluated uterine closure techniques and reported on ultrasound findings, perioperative or long-term outcomes.Data Collection and Analysis: Twenty studies (15 053 women) were included in our meta-analyses for various outcomes. We calculated pooled risk ratios (RR) and weighted mean differences (WMD) with 95% CI through random-effect analysis.Main Results: Residual myometrium thickness (RMT), reported in eight studies (508 women), decreased by 1.26 mm after single- compared with double-layer closure (95% CI -1.93 to -0.58), particularly when locked sutures were used. Healing ratio [RMT/adjacent myometrium thickness (AMT)] decreased after single-layer closure (WMD -7.74%, 95% CI -13.31 to -2.17), particularly in the case of locked sutures. Niche prevalence increased (RR 1.71, 95% CI 1.11-2.62) when the decidua was excluded. Dysmenorrhea occurred more often in the single-layer group (RR 1.23, 95% CI 1.01-1.48), whereas incidence of uterine rupture was similar (RR 1.91, 95% CI 0.63-5.74).Conclusion: Double-layer unlocked sutures are preferable to single-layer locked sutures regarding RMT, healing ratio and dysmenorrhoea. Excluding the decidua seems to result in higher niche prevalence. As thin residual myometrium or niches may serve as intermediates for gynaecological and reproductive outcomes, future studies should focus on these outcomes. TWEETABLE ABSTRACT: #Uterineclosuretechniques after #caesarean affect #longtermoutcomes. [ABSTRACT FROM AUTHOR]

Published
2018
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47. Pregnancy Outcome After Fetal Reduction in Women With a Dichorionic Twin Pregnancy

Author

van de Mheen, L., primary, Everwijn, S. M. P., additional, Knapen, M. F. C. M., additional, Haak, M. C., additional, Engels, M. A. J., additional, Manten, G. T. R., additional, Zondervan, H. A., additional, Wirjosoekarto, S. A. M., additional, van Vugt, J. M. G., additional, Erwich, J. J. H. M., additional, Bilardo, C. M., additional, van Pampus, M. G., additional, de Groot, C. J. M., additional, Mol, B. W. J., additional, and Pajkrt, E., additional

Published
2015
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48. Liever inleiden dan afwachten bij aterme zwangerschapshypertensie en milde preëclampsie: HYPITAT-studie*

Author

Koopmans, C. M., Bijlenga, D., Groen, H., Vijgen, S. M. C., Aarnoudse, J. G., Bekedam, D. J., van den Berg, P. P., de Boer, K., Burggraaff, J. M., Bloemenkamp, K. W. M., Drogtrop, A. P., Franx, A., de Groot, C. J. M., Huisjes, A. J. M., Kwee, A., van Loon, A. J., Lub, A., Papatsonis, D. N. M., van der Post, J. A. M., Roumen, F. J. M. E., Scheepers, H. C. J., Willekes, C., Mol, B. W. J., van Pampus, M. G., Obstetrics and gynaecology, ICaR - Ischemia and repair, Science in Healthy Ageing & healthcaRE (SHARE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Guided Treatment in Optimal Selected Cancer Patients (GUTS), Reproductive Origins of Adult Health and Disease (ROAHD), Other departments, Amsterdam Reproduction & Development (AR&D), Obstetrics and Gynaecology, and Amsterdam Public Health

Subjects
reproductive and urinary physiology
Abstract

OBJECTIVE: To investigate what would benefit women with mild full-term pregnancy-related hypertension most: induction of labour or expectant monitoring, from the perspective of clinical effectiveness, maternal quality of life, and costs. DESIGN: Randomised clinical trial. Trial registration number ISRCTN08132825. METHODS: We undertook a multicentre randomised controlled trial in 38 hospitals in the Netherlands between October 2005 and March 2008. We enrolled patients with a singleton pregnancy in cephalic presentation at 36-41 weeks' gestation, who had gestational hypertension or mild preeclampsia. Participants were randomly allocated to receive either induction of labour or expectant monitoring. The primary outcome was a composite measure of poor maternal outcome, defined as maternal mortality, maternal morbidity (eclampsia, 'haemolysis, elevated liver enzymes, low platelets' (HELLP) syndrome, pulmonary oedema, thrombo-embolic disease and abruptio placentae), progression to severe hypertension or proteinuria, and major postpartum haemorrhage. Secondary outcomes were mode of delivery, neonatal outcome, maternal quality of life and costs. Analysis was by intention to treat. RESULTS: A total of 756 patients were allocated to receive induction of labour (n = 377 patients) or expectant monitoring (n = 379). No cases of maternal or neonatal death or eclampsia were recorded. Development of poor maternal outcome was significantly lower in the induction of labour group (117 women) than the expectant monitoring group (166 women) (31% versus 44%; relative risk 0.71 (95% CI: 0.59-0.86); p < 0.001). The caesarean section rate was lower among women in the induction of labour group (n = 54) compared to women in the expectant monitoring group (n = 72) (14% versus 19%; relative risk 0.75 (95% CI: 0.55-1.04)< p = 0.085). Neonatal outcomes and quality of life were comparable between both groups. Induction of labour is a cost saving strategy (difference euro 831). CONCLUSION: For women with full-term gestational hypertension and pre-eclampsia, induction of labour is associated with improved maternal outcome and lower costs, without the additional risk of a caesarean section being necessary

Published
2010

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