{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T13:18:51Z","timestamp":1761743931393},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,7,14]],"date-time":"2014-07-14T00:00:00Z","timestamp":1405296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the risks and benefits of routine labour induction at 41<jats:sup>+0<\/jats:sup>\u00a0weeks' gestation for mother and newborn.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Population\u2010based retrospective cohort study of inter\u2010institutional variation in labour induction practices for women at or beyond 41<jats:sup>+0<\/jats:sup>\u00a0weeks' gestation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women in British Columbia, Canada, who remained pregnant \u226541<jats:sup>+0<\/jats:sup>\u00a0weeks and delivered at one of the province's 42 hospitals with &gt;50 annual deliveries, 2008\u20132012 (<jats:italic>n<\/jats:italic>\u00a0=\u00a014\u00a0627).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The proportion of women remaining pregnant a week or more past the expected delivery date who were induced at 41<jats:sup>+0<\/jats:sup> or 41<jats:sup>+1<\/jats:sup>\u00a0weeks' gestation for an indication of \u2018post\u2010dates\u2019 was calculated for each institution. We used instrumental variable analysis (using the institutional rate of labour induction\u00a0at 41<jats:sup>+0<\/jats:sup>\u00a0weeks as the instrument) to estimate the effect of labour induction on maternal and neonatal health outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Caesarean delivery, instrumental delivery, post\u2010partum haemorrhage, 3rd or 4th degree lacerations, macrosomia, neonatal intensive care unit admission, and 5\u2010minute Apgar score &lt;7.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Institutional rates of labour induction at 41<jats:sup>+0<\/jats:sup>\u00a0weeks ranged from 14.3 to 46%. Institutions with higher (\u226530%) and average (20\u201329.9%) induction rates did not have significantly different rates of caesarean delivery, instrumental delivery, or other maternal or neonatal outcomes than institutions with lower induction rates (&lt;20%). Instrumental variable analyses also demonstrated no significantly increased (or decreased) risk of caesarean delivery (0.69 excess cases per 100 pregnancies [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u221210.1, 11.5]), instrumental delivery (8.9 per 100 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22122.3, 20.2]), or other maternal or neonatal outcomes in women who were induced (versus not induced).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Within the current range of clinical practice, there was no evidence that differential use of routine induction at 41<jats:sup>+0<\/jats:sup>\u00a0weeks affected maternal or neonatal health outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13007","type":"journal-article","created":{"date-parts":[[2014,7,15]],"date-time":"2014-07-15T18:18:03Z","timestamp":1405448283000},"page":"973-981","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Using inter\u2010institutional practice variation to understand the risks and benefits of routine labour induction at 41<sup>+0<\/sup>\u00a0weeks"],"prefix":"10.1111","volume":"122","author":[{"given":"JA","family":"Hutcheon","sequence":"first","affiliation":[{"name":"Perinatal Services British Columbia Provincial Health Services Authority Vancouver British Columbia Canada"},{"name":"Department of Obstetrics &amp; Gynaecology University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Harper","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EC","family":"Strumpf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal Quebec Canada"},{"name":"Department of Economics McGill University Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Lee","sequence":"additional","affiliation":[{"name":"Perinatal Services British Columbia Provincial Health Services Authority Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G","family":"Marquette","sequence":"additional","affiliation":[{"name":"Perinatal Services British Columbia Provincial Health Services Authority Vancouver British Columbia Canada"},{"name":"Department of Obstetrics &amp; Gynaecology University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,7,14]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"CD004945","article-title":"Induction of labour for improving birth outcomes for women at or beyond term","author":"Gulmezoglu AM","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2002.01004.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00007"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199206113262402"},{"key":"e_1_2_6_6_1","volume-title":"WHO Recommendations for Induction of Labour","author":"World Health Organization","year":"2011"},{"key":"e_1_2_6_7_1","first-page":"1","article-title":"Maternal and neonatal outcomes of elective induction of labor","volume":"176","author":"Caughey AB","year":"2009","journal-title":"Evid Rep Technol Assess (Full Rep)"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)32945-0"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30584-3"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.19.1.17"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000193606.58671.c5"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.4.1064"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.3.278"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520110039026"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2393"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1198\/073500102288618658"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60736-4"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2838"},{"key":"e_1_2_6_19_1","first-page":"1145","article-title":"Effect of labour induction on rates of stillbirth and caesarean section in post\u2010term pregnancies","volume":"160","author":"Sue\u2010A\u2010Quan AK","year":"1999","journal-title":"Can Med Assoc J"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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