The age of childbearing is rising in women living in industrialised nations. Advanced maternal age is associated with a small increased risk of term antepartum stillbirth. Labour induction would likely reduce stillbirth, but might also increase Caesarean delivery, already high for older women. The aim of this thesis was to design and conduct a randomised controlled trial of induction of labour at 39 weeks versus expectant management for nulliparous women aged over 35 years. In total 619 women participated and the trial showed that induction of labour has no adverse short-term effects on maternal or neonatal outcomes. In particular, it does not increase caesarean section rate. A cost-utility analysis of the trial was performed and demonstrated that induction of labour is associated with a small gain in QALYs and is not more expensive than expectant management. One key secondary outcome of the trial was maternal satisfaction. There is a lack of a robust validated tool for evaluating labour experience in the UK therefore a study of 350 women was performed to validate a Swedish instrument (Childbirth Experience Questionnaire) in the UK. This study demonstrates that the Childbirth Experience Questionnaire is a valid and reliable measure of childbirth experience in the UK population. A study examining the causes of 2850 cases of antepartum stillbirth in women of advanced maternal age using anonymised national data found that stillbirths in women over 35 years old are more likely to be due to major congenital anomalies, mechanical causes, maternal disorders or associated obstetric factors than women less than 35. In 2013, a systematic review of randomised controlled trials of induction of labour versus expectant management at term found that a policy of induction was associated with a 17% reduction in the risk of caesarean section. An IPD meta-analysis of induction of labour versus expectant management at term in women with intact membranes by subgroups of maternal age has shown that induction in women of advanced maternal age has no statistically significant effect on caesarean section rates.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:718852 |
| Date | January 2016 |
| Creators | Walker, Kate Frances |
| Publisher | University of Nottingham |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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