{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:42:38Z","timestamp":1787920958043,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["16\/77\/02"],"award-info":[{"award-number":["16\/77\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The cost\u2010effectiveness of early induction of labour for suspected large\u2010for\u2010gestational\u2010age foetuses to prevent shoulder dystocia is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A within\u2010trial economic evaluation of induction at 38\u2009+\u20090 to 38\u2009+\u20094\u2009weeks' gestation for suspected large\u2010for\u2010gestational\u2010age foetuses. Resource use and costs were measured to 6\u2009months postpartum. We estimated incremental cost per case of shoulder dystocia prevented and incremental cost per maternal quality\u2010adjusted life year (QALY) gained. We collected data for planned caesarean sections in a cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Mean combined woman and infant costs in the induction arm were \u00a389 (95% confidence interval (CI): \u2212\u00a379, \u00a3257) higher than the standard care arm, driven by increased neonatal costs. The incremental cost of preventing one case of shoulder dystocia was \u00a311\u2009879 and the incremental cost per maternal QALY gained was \u00a339\u2009518. The probability of early induction being cost\u2010effective was 0.65 at a cost\u2010effectiveness threshold of \u00a320\u2009000 per case of shoulder dystocia prevented, but 0.36 at a cost\u2010effectiveness threshold of \u00a320\u2009000 per maternal QALY gained. The cohort study found the mean cost was \u00a3310 (95% CI: \u00a374, \u00a3545) higher in the induction arm than in the planned caesarean group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Early induction of labour increased neonatal care costs. It is not a cost\u2010effective approach when effects are restricted to maternal QALYs. Planned caesarean section might be cost\u2010saving when compared to early induction, although we did not assess longer\u2010term effects such as an increased risk of repeat caesarean sections. Assessments of long\u2010term effects on the mother and infant should be incorporated into future studies.<\/jats:p><jats:p><jats:bold>Trial Registration:<\/jats:bold> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/bmjopen.bmj.com\/external-ref?link_type=ISRCTN&amp;access_num=ISRCTN18229892\">ISRCTN18229892<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18160","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T18:30:58Z","timestamp":1746124258000},"page":"1250-1258","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Is It Cost\u2010Effective to Induce Labour Early to Prevent Shoulder Dystocia? Evidence From the Big Baby Trial"],"prefix":"10.1111","volume":"132","author":[{"given":"Seyran","family":"Naghdi","sequence":"first","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-6050","authenticated-orcid":false,"given":"Stavros","family":"Petrou","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Underwood","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick  Coventry UK"},{"name":"University Hospitals Coventry and Warwickshire  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Deshpande","sequence":"additional","affiliation":[{"name":"Shrewsbury and Telford Hospitals NHS Trust  Telford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan","family":"Quenby","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire  Coventry UK"},{"name":"Warwick Biomedical Sciences University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Ewington","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry and Warwickshire  Coventry UK"},{"name":"Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3230-1292","authenticated-orcid":false,"given":"Jason","family":"Gardosi","sequence":"additional","affiliation":[{"name":"Warwick Medical School University of Warwick  Coventry UK"},{"name":"Perinatal Institute  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-1160","authenticated-orcid":false,"given":"Hema","family":"Mistry","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit University of Warwick  Coventry UK"},{"name":"University Hospitals Coventry and Warwickshire  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-015-2863-x"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2014.04.002"},{"key":"e_1_2_13_4_1","unstructured":"Health Services Safety Investigations Body \u201cSevere Brain Injury Early Neonatal Death and Intrapartum Stillbirth Associated With Larger Babies and Shoulder Dystocia \u201d accessed October 02 2023 https:\/\/www.hssib.org.uk\/patient\u2010safety\u2010investigations\/severe\u2010brain\u2010injury\u2010early\u2010neonatal\u2010death\u2010and\u2010intrapartum\u2010stillbirth\u2010associated\u2010with\u2010larger\u2010babies\u2010and\u2010shoulder\u2010dystocia\/."},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S175088"},{"key":"e_1_2_13_6_1","article-title":"Induction of Labour at or Near Term for Suspected Fetal Macrosomia","volume":"2016","author":"Boulvain M.","year":"2016","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14435"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(25)00162\u2010X"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0249031"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsg.2019.12.001"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.06.030"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1356262213486434"},{"key":"e_1_2_13_13_1","unstructured":"\u201cGood Practice: Management of Shoulder Dystocia \u201d accessed October 02 2023 https:\/\/resolution.nhs.uk\/resources\/good\u2010practice\u2010management\u2010of\u2010shoulder\u2010dystocia\/."},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-058176"},{"key":"e_1_2_13_15_1","volume-title":"Guide to the Methods of Technology Appraisal","author":"National Institute for Health and Care Excellence (NICE)","year":"2018"},{"key":"e_1_2_13_16_1","unstructured":"NHS England and NHS Improvement \u201cNational Tariff Payment System: Annex A \u2013 National Tariff Workbook\u20102022\/23 \u201d (2023)."},{"key":"e_1_2_13_17_1","unstructured":"NHS Trusts and NHS Foundation Trusts \u201cNational Cost Collection: National Schedule of NHS Costs \u2013 Year 2021\/22 \u201d (2023)."},{"key":"e_1_2_13_18_1","unstructured":"K. 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