增加引产使用与降低剖宫产率之间的关联。
The association between increased use of labor induction and reduced rate of cesarean delivery.
机构信息
Department of Family Practice and Community Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania19104, USA.
出版信息
J Womens Health (Larchmt). 2009 Nov;18(11):1747-58. doi: 10.1089/jwh.2007.0449.
AIM
An association was recently reported between a low cesarean section delivery rate and a method of obstetrical care that involved the frequent use of risk-guided prostaglandin-assisted preventive labor induction. We sought to confirm this finding in a subsequent group of pregnant women.
METHODS
A retrospective cohort study design was used to compare the outcomes of 100 consecutively delivered women, who were exposed to the alternative method of care, with the outcomes of 300 randomly chosen women who received standard management. The primary outcome was group cesarean delivery rate. Secondary outcomes were rates of neonatal intensive care unit admission, low 1-minute Apgar score, low 5-minute Apgar score, and major perineal trauma.
RESULTS
Women exposed to the alternative method of obstetrical care had a higher induction rate (59% vs. 16.3%, p < 0.001), a more frequent use of prostaglandins for cervical ripening (32% vs. 13%, p < 0.001), and a lower cesarean delivery rate (7% vs. 20.3%, p = 0.002). Exposed women did not experience higher rates of other adverse birth outcomes.
CONCLUSIONS
Exposure to an alternative method of obstetrical care that used high levels of risk-driven prostaglandin-assisted labor was again associated with two findings: a lower group cesarean delivery rate and no increases in levels of other adverse birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.
目的
最近有报道称，剖宫产率低与一种产科护理方法有关，该方法频繁使用风险导向的前列腺素辅助预防性引产。我们试图在随后的一组孕妇中证实这一发现。
方法
采用回顾性队列研究设计，比较了 100 例连续分娩的妇女（暴露于替代护理方法）和 300 例随机选择的接受标准管理的妇女的结局。主要结局是组剖宫产率。次要结局是新生儿重症监护病房入院率、低 1 分钟 Apgar 评分、低 5 分钟 Apgar 评分和严重会阴创伤发生率。
结果
接受替代产科护理方法的妇女引产率较高（59%比 16.3%，p<0.001），前列腺素用于宫颈成熟的使用率更高（32%比 13%，p<0.001），剖宫产率较低（7%比 20.3%，p=0.002）。暴露组妇女未经历更高的其他不良分娩结局发生率。
结论
再次发现，接受高水平风险驱动前列腺素辅助引产的替代产科护理方法与两个发现相关：组剖宫产率较低，其他不良分娩结局发生率没有增加。需要一项充分的随机对照试验来进一步探讨这种替代护理方法。
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