Michelson Kenneth A, Carr Darcy B, Easterling Thomas R
College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Am J Obstet Gynecol. 2008 Sep;199(3):299.e1-4. doi: 10.1016/j.ajog.2008.06.072.
We sought to determine maternal factors that influence success of labor induction and whether the probability of cesarean delivery changed with time during induction.
We performed a retrospective cohort study of 1650 singleton pregnancies induced at a gestation of 37 weeks or longer, with birthweights of 2500 g or greater, and without congenital anomalies. We used multivariate logistic regression to calculate odds ratios for cesarean.
Nulliparity (odds ratio [OR] 7.8, 95% confidence interval [CI] 5.7 to 11), hypertension (OR 1.4, 95% CI 1.1 to 1.8), diabetes (OR 2.2, 95% CI 1.6 to 3.1), maternal age 28.8 years old or older (OR 1.3, 95% CI 1.2 to 1.4), and birthweight of 3441 g or greater (OR 1.6, 95% CI 1.2 to 2.0) were significantly associated with cesarean. Cesarean risk increased linearly with time by an average of 3.8% per 6 hours.
Risk of cesarean increases over the duration of induction but does not reach clinical certainty. Cesarean probability is greater with nulliparity, hypertension, diabetes, older maternal age, or higher birthweight. Inductions without stated indications may not carry an increased risk of cesarean.
我们试图确定影响引产成功的母体因素，以及剖宫产概率在引产过程中是否随时间变化。
我们对1650例单胎妊娠进行了一项回顾性队列研究，这些妊娠在孕37周或更长时间引产，出生体重2500克或以上，且无先天性异常。我们使用多因素逻辑回归计算剖宫产的比值比。
初产妇（比值比[OR]7.8，95%置信区间[CI]5.7至11）、高血压（OR 1.4，95%CI 1.1至1.8）、糖尿病（OR 2.2，95%CI 1.6至3.1）、产妇年龄28.8岁及以上（OR 1.3，95%CI 1.2至1.4）以及出生体重3441克及以上（OR 1.6，95%CI 1.2至2.0）与剖宫产显著相关。剖宫产风险每6小时平均以3.8%的速度线性增加。
剖宫产风险在引产过程中增加，但未达到临床确定性。初产妇、高血压、糖尿病、产妇年龄较大或出生体重较高时剖宫产概率更高。无明确指征的引产可能不会增加剖宫产风险。
