INDEX: Costs and effects of induction of labour versus expectant management in women with impending post-term pregnancies: the 41-42 weeks dilemma

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Post-term pregnancy is associated with increased perinatal morbidity and mortality and is considered as a high-risk stage which requires specialist surveillance and induction of labour at some stage. However, there is uncertainty in the Netherlands on the policy concerning the timing of induction for post-term pregnancy, leading to practice variation and strong debates between caregivers regarding pros and cons of labour induction for impending post-term pregnancy.
To solve this dilemma in the Netherlands we conduct a randomised trial to evaluate the effectiveness, costs and cost-effectiveness analysis of policy of labour induction at 41 weeks versus expectant management until 42 weeks in low risk women. We will study adverse neonatal outcome, adverse maternal outcomes, client satisfaction, preferences and costs.


To compare a policy of labour induction at 41 weeks with a policy of expectant management until 42 weeks. Based on the data obtained, we will perform a cost-effectiveness analysis incorporating instrumental delivery rates, client satisfaction and costs.


Will induction at 41 weeks improve perinatal outcomes at acceptable cost compared to a policy of expectant management until 42 weeks?

What is the perinatal mortality and neonatal morbidity in a policy of induction of labour at 41 weeks as compared to a policy of expectant management until 42 weeks. And what is the instrumental delivery rate including caesarean sections, need for pain relieve, perineal injury, postpartum hemorrhage, use of health care resources, maternal satisfaction and clients’ preferences?


The ultimate goal of the project is to come to a uniform guideline of the Royal Dutch Organisation of Midwives and the Dutch Society for Obstetrics and Gynaecology.


Dr. E. de Miranda, verloskundige AMC Amsterdam
Prof.dr. B.W. Mol, gynaecoloog AMC Amsterdam


Drs. J. Kortekaas Drs. J. Keulen Drs. A. Bruinsma


Het betreft een Consortium-studie vanuit het AMC (MSc Verloskunde-Afd. Verloskunde) in samenwerking met het MRN, VUMC, AV-M en KNOV.


Begindatum: januari 2012
Einddatum: december 2015

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