{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T20:48:27Z","timestamp":1694465307879},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,3,8]],"date-time":"2018-03-08T00:00:00Z","timestamp":1520467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Elevated human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) have been linked to placental dysfunction and associated morbidities. We aimed to compare the induction of labor with expectant management at term in those pregnancies for the prevention of neonatal and maternal morbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women with second trimester HCG \u2265 2 and\/or AFP \u2265 2 multiples of the median, without additional maternal or fetal complications, from their 38th gestational week were offered the choice of labor induction or expectant management. The primary outcomes were maternal composite outcome (composed of cesarean deliveries, pre\u2010eclampsia or placental abruption) and neonatal composite outcome (composed of antenatal or neonatal death, Apgar score at 5 min &lt; 7, admission to the neonatal intensive care unit, need for phototherapy, respiratory abnormalities, birth trauma or neonatal infection).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 305 women, 124 women chose to undergo labor induction, and 181 women chose expectant management. The composite maternal outcome in the expectant management group was twice the rate of the labor induction group, although it did not reach statistical significance (18 [10%] vs 6 [5%]; <jats:italic>P<\/jats:italic> = 0.1; relative risk [expectant\/induced] 2.04; 95% confidence interval 0.8\u20135.0).<\/jats:p><jats:p>Increased rate of phototherapy led to increased neonatal composite outcomes in the labor induction group compared with the expectant management group (34 [27%] vs 27 [15%], respectively = 0.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In pregnancies with elevated AFP and\/or HCG, early term labor induction initiated a trend towards improvement in maternal outcome but increased the rate of mild neonatal morbidity. The statistical insignificance of the large effect on the maternal outcome might reflect the lack of statistical power. Further research is needed to address this limitation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.13618","type":"journal-article","created":{"date-parts":[[2018,3,8]],"date-time":"2018-03-08T08:42:37Z","timestamp":1520498557000},"page":"1049-1056","source":"Crossref","is-referenced-by-count":1,"title":["Labor induction versus expectant management at early term in pregnancies with second trimester elevated human chorionic gonadotropin or alpha fetoprotein"],"prefix":"10.1111","volume":"44","author":[{"given":"Enav","family":"Yefet","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Kuzmin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naama","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Research Authority Emek Medical Center  Afula Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flora","family":"Basson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zohar","family":"Nachum","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Emek Medical Center  Afula Israel"},{"name":"Rappaport Faculty of Medicine Technion  Haifa Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,3,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2009.04.017"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2014.07.018"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(95)00390-8"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199107043250102"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(03)00081-2"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(00)01109-1"},{"key":"e_1_2_6_8_1","first-page":"929","article-title":"Adverse obstetric outcome in low\u2010 and high\u2010 risk pregnancies: Predictive value of maternal serum screening","volume":"94","author":"Rijn M","year":"1999","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181b48ef5"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61904-8"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.130925"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2015.1066774"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0803267"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.07.022"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000172419.37410.eb"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30331-5"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01747-1"},{"key":"e_1_2_6_18_1","first-page":"311","article-title":"Birth weight standards in the live\u2010born population in Israel","volume":"7","author":"Dollberg S","year":"2005","journal-title":"Isr Med Assoc J"},{"key":"e_1_2_6_19_1","first-page":"625","article-title":"Abruptio placentae. 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