Results
From 1 January 2012 to 31 December 2017, there were 1,776 women aged ≥
40 years who delivered at Álvaro Cunqueiro Hospital. Women who had
multiple gestations and women delivering at < 39 weeks of
gestation were excluded. There were a total of 603 pregnant women in the
expectant management group compared to 634 women in the induction group.
Baseline characteristics were similar between the two groups (Table 1).
The delivery outcomes are shown in Table 2. There was no significant
difference in the rate of caesarean section between the induction and
expectant management groups (24% vs. 24.4%) (p=0,971). The risk of
urgent intrapartum caesarean section was 44.1% in the induction group
versus 33.1% in the expectant management group; these differences were
not significant (p=0,127).
A secondary analysis showed that in the group of women without any
previous surgical or vaginal delivery, the distribution according to the
type of labour did not show statistically significant differences
between groups (p= 0,109). The rate of successful trial of labour after
caesarean (TOLAC) was 57.3% in the expectant management group and
51.2% in the induction group. These differences were not statistically
significant (p=0,247). There were significant between-group differences
in the frequency of stained amniotic fluid (147 of 603 in the expectant
management group [24.4%] versus 89/634 in the induction of labour
group [10.9%] ).
The neonatal outcomes are presented in Table 3. No statistically
significant differences were found for the Apgar value at 5 min and
umbilical artery pH value. There were two cases of stillbirth in the
expectant management group, and no intrauterine foetal deaths were
registered in the induction group. These differences were not
statistically significant (P =0,147). The expectant management group
needed more advanced paediatric support at birth than the labour
induction group. (Table 4). The rate of admission to the NICU was lower
in the labour induction group (p=0,000) than that in the expectant
management group.