{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:30:18Z","timestamp":1789677018851,"version":"4.0.1"},"reference-count":53,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T00:00:00Z","timestamp":1550620800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare induction of labour at 41 weeks with expectant management until 42 weeks in low risk women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Open label, randomised controlled non-inferiority trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>123 primary care midwifery practices and 45 hospitals (secondary care) in the Netherlands, 2012-16.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1801 low risk women with an uncomplicated singleton pregnancy: randomised to induction (n=900) or to expectant management until 42 weeks (n=901).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Induction at 41 weeks or expectant management until 42 weeks with induction if necessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome was a composite of perinatal mortality and neonatal morbidity (Apgar score &lt;7 at five minutes, arterial pH &lt;7.05, meconium aspiration syndrome, plexus brachialis injury, intracranial haemorrhage, and admission to a neonatal intensive care unit (NICU). Secondary outcomes included maternal outcomes and mode of delivery. The null hypothesis that expectant management is inferior to induction was tested with a non-inferiority margin of 2%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median gestational age at delivery was 41 weeks+0 days (interquartile range 41 weeks+0 days-41 weeks+1 day) for the induction group and 41 weeks+2 days (41 weeks+0 days-41 weeks+5 days) for the expectant management group. The primary outcome was analysed for both the intention-to-treat population and the per protocol population. In the induction group, 15\/900 (1.7%) women had an adverse perinatal outcome versus 28\/901 (3.1%) in the expectant management group (absolute risk difference \u22121.4%, 95% confidence interval \u22122.9% to 0.0%, P=0.22 for non-inferiority). 11 (1.2%) infants in the induction group and 23 (2.6%) in the expectant management group had an Apgar score &lt;7 at five minutes (relative risk (RR) 0.48, 95% CI 0.23 to 0.98). No infants in the induction group and three (0.3%) in the expectant management group had an Apgar score &lt;4 at five minutes. One fetal death (0.1%) occurred in the induction group and two (0.2%) in the expectant management group. No neonatal deaths occurred. 3 (0.3%) neonates in the induction group versus 8 (0.9%) in the expectant management group were admitted to an NICU (RR 0.38, 95% CI 0.10 to 1.41). No significant difference was found in composite adverse maternal outcomes (induction n=122 (13.6%)\n                      <jats:italic>v<\/jats:italic>\n                      expectant management n=102 (11.3%)) or in caesarean section rate (both groups n=97 (10.8%)).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study could not show non-inferiority of expectant management compared with induction of labour in women with uncomplicated pregnancies at 41 weeks; instead a significant difference of 1.4% was found for risk of adverse perinatal outcomes in favour of induction, although the chances of a good perinatal outcome were high with both strategies and the incidence of perinatal mortality, Apgar score &lt;4 at five minutes, and NICU admission low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Netherlands Trial Register NTR3431.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.l344","type":"journal-article","created":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T23:55:16Z","timestamp":1550706916000},"page":"l344","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":88,"title":["Induction of labour at 41 weeks versus expectant management until 42 weeks (INDEX): multicentre, randomised non-inferiority trial"],"prefix":"10.1136","author":[{"given":"Judit KJ","family":"Keulen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aafke","family":"Bruinsma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep C","family":"Kortekaas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"van Dillen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick MM","family":"Bossuyt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn A","family":"Oudijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben G","family":"Duijnhoven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton H","family":"van Kaam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank PHA","family":"Vandenbussche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joris AM","family":"van der Post","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben Willem","family":"Mol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0392-4626","authenticated-orcid":false,"given":"Esteriek","family":"de Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,2,20]]},"reference":[{"key":"key20190314145725_ref1","first-page":"7","article-title":"International classification of diseases","volume":"19","author":"WHO Collaborating Centers","year":"1998","journal-title":"Epidemiol Bull"},{"key":"key20190314145725_ref2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1998.tb10047.x"},{"key":"key20190314145725_ref3","doi-asserted-by":"publisher","DOI":"10.3109\/00016349709024606"},{"key":"key20190314145725_ref4","doi-asserted-by":"publisher","DOI":"10.1080\/00016340500543733"},{"key":"key20190314145725_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgyn.2011.09.007"},{"key":"key20190314145725_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgyn.2011.09.006"},{"key":"key20190314145725_ref7","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2011.43"},{"key":"key20190314145725_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmwh.2008.12.011"},{"key":"key20190314145725_ref9","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000437385.88715.4a"},{"key":"key20190314145725_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2013.01.026"},{"key":"key20190314145725_ref11","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000452744.06088.48"},{"key":"key20190314145725_ref12","doi-asserted-by":"publisher","DOI":"10.1515\/jpm.2010.057"},{"key":"key20190314145725_ref13","first-page":"8","article-title":"Induction of labour: new NICE quality standard","volume":"17","year":"2014","journal-title":"Midwives"},{"key":"key20190314145725_ref14","unstructured":"Workgroup. 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