{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T14:47:36Z","timestamp":1790174856696,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T00:00:00Z","timestamp":1463097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate caesarean section and adverse neonatal outcome rates after induction of labour or expectant management in women with an unripe cervix at or near term.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Secondary analysis of data from two randomised clinical trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Data were collected in two nationwide Dutch trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women with hypertensive disease (<jats:styled-content style=\"fixed-case\">HYPITAT<\/jats:styled-content> trial) or suspected fetal growth restriction (<jats:styled-content style=\"fixed-case\">DIGITAT<\/jats:styled-content> trial) and a Bishop score \u22646.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Comparison of outcomes after induction of labour and expectant management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Rates of caesarean section and adverse neonatal outcome, defined as 5\u2010minute Apgar score \u22646 and\/or arterial umbilical cord <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> &lt;7.05 and\/or neonatal intensive care unit admission and\/or seizures and\/or perinatal death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1172 included women with an unripe cervix, 572 had induction of labour and 600 had expectant management. We found no significant difference in the overall caesarean rate (difference \u22121.1%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22125.4 to 3.2). Induction of labour did not increase caesarean rates in women with Bishop scores from 3 to 6 (difference \u22122.7%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22127.6 to 2.2) or adverse neonatal outcome rates (difference \u22121.5%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22124.3 to 1.3). However, there was a significant difference in the rates of arterial umbilical cord <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> &lt;7.05 favouring induction (difference \u22123.2%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22125.6 to \u22120.9). The number needed to treat to prevent one case of umbilical arterial <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> &lt;7.05 was 32.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found no evidence that induction of labour increases the caesarean rate or compromises neonatal outcome as compared with expectant management. Concerns over increased risk of failed induction in women with a Bishop score from 3 to 6 seem unwarranted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Induction of labour at low Bishop scores does not increase caesarean section rate or poor neonatal outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14028","type":"journal-article","created":{"date-parts":[[2016,5,13]],"date-time":"2016-05-13T08:08:09Z","timestamp":1463126889000},"page":"1501-1508","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Caesarean section rates and adverse neonatal outcomes after induction of labour versus expectant management in women with an unripe cervix: a secondary analysis of the <scp>HYPITAT<\/scp> and <scp>DIGITAT<\/scp> trials"],"prefix":"10.1111","volume":"123","author":[{"given":"TP","family":"Bernardes","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Groningen University Medical Centre Groningen Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Broekhuijsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; 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