Browsing by Author "Knight, H."

Now showing 1 - 3 of 3
  • No Thumbnail Available
    ItemOpen Access
    Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation and parity: a national cohort study in England.
    (PLOS Medicine, 2023-07-20) Muller, P.; Karia, A. M.; Webster, K.; Carroll, F.; Dunn, G.; Frémeaux, A.; Harris, T.; Knight, H.; Oddie, S.; Khalil, A.; van der Meulen, J.; Gurol-Urganci, I.
    Background: Ethnic and socioeconomic inequalities in obstetric outcomes are well established. However, the role of induction of labour (IOL) to reduce these inequalities is controversial, in part due to insufficient evidence. This national cohort study aimed to identify adverse perinatal outcomes associated with IOL with birth at 39 weeks of gestation (“IOL group”) compared to expectant management (“expectant management group") according to maternal characteristics in women with low-risk pregnancies. Methods and Findings: All English National Health Service (NHS) hospital births between January 2018 and March 2021 were examined. Using the Hospital Episode Statistics (HES) dataset, maternal and neonatal data (demographic, diagnoses, procedures, labour, and birth details) were linked, with neonatal mortality data from the Office for National Statistics (ONS). Women with a low-risk pregnancy were identified by excluding pregnancies with pre-existing comorbidities, previous caesarean section, breech presentation, placenta previa, gestational diabetes, or a baby with congenital abnormalities. Women with premature rupture of membranes, placental abruption, hypertensive disorders of pregnancy, amniotic fluid abnormalities, or antepartum stillbirth were excluded only from the IOL group. Adverse perinatal outcome was defined as stillbirth, neonatal death or neonatal morbidity, the latter identified using the English composite neonatal outcome indicator (E-NAOI). Binomial regression models estimated risk differences (with 95% confidence intervals) between the IOL group and the expectant management group, adjusting for ethnicity, socioeconomic background, maternal age, parity, year of birth, and birthweight centile. Interaction tests examined risk differences according to ethnicity, socioeconomic background, and parity. Of the 1 567 004 women with singleton pregnancies, 501 072 women with low-risk pregnancies and with sufficient data quality were included in the analysis. 3.3% of births in the IOL group (1 555/47 352) and 3.6% in the expectant management group (16 525/453 720) had an adverse perinatal outcome. After adjustment, a lower risk of adverse perinatal outcomes was found in the IOL group (risk difference -0.28%; 95% confidence interval -0.43%, -0.12%; p=0.001). This risk difference varied according to socioeconomic background from 0.38% ( 0.08%, 0.83%) in the least deprived to -0.48% ( 0.76%, -0.20%) in the most deprived national quintile (p value for interaction =0.01), and by parity with risk difference of -0.54% (-0.80%, -0.27%) in nulliparous women and -0.15% (-0.35%, 0.04%) in multiparous women (p-value for interaction = 0.02). There was no statistically significant evidence that risk differences varied according to ethnicity (p=0.19). Key limitations included absence of additional confounding factors such as smoking, BMI, and the indication for induction in the HES datasets, which may mean some higher risk pregnancies were included. Conclusions: IOL with birth at 39 weeks was associated with a small reduction in the risk of adverse perinatal outcomes, with 360 inductions in low-risk pregnancies needed to avoid one adverse outcome. The risk reduction was mainly present in women from more socioeconomically deprived areas and in nulliparous women. There was no significant risk difference found by ethnicity. Increased uptake of IOL at 39 weeks, especially in women from more socioeconomically deprived areas, may help reduce inequalities in adverse perinatal outcomes.
  • No Thumbnail Available
    ItemMetadata only
    National Maternity and Perinatal Audit: Organisational Report 2017
    (Royal College of Obstetricians and Gynaecologists, 2017) Blotkamp, A.; Cromwell, D.; Dumbrill, B.; Gurol-Urganci, I.; Hawdon, J.; Jardine, J.; Harris, Tina; Knight, H.; McDougal, L.; Moitt, N.; Pasupathy, D.; van der Meulen, J.
    Organisational report 2017 - A snapshot of NHS maternity and neonatal services in England, Scotland and Wales in January 2017
  • No Thumbnail Available
    ItemMetadata only
    Rapid Response: Re:Risk of complicated birth at term in nulliparous and multiparous women using routinely collected data in England: cohort study. Rapid Response
    (BMJ Publishing Group, 2020-10-23) Pasupathy, D.; Jardine, J.; Harris, Tina; Hawdon, J.; Blotkamp, A.; Knight, H.; Gurol-Urganci, I.; Walker, K.; van der Meulen, J.
    De Jonge et al express concerns about the use of the term 'trial of labour' and our interpretation of the results.