孕37至41周低风险妊娠的择期引产和择期剖宫产结局。

Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks' gestation.

作者信息

Dunne Caitlin, Da Silva Orlando, Schmidt Gail, Natale Renato

机构信息

Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.

出版信息

J Obstet Gynaecol Can. 2009 Dec;31(12):1124-30. doi: 10.1016/s1701-2163(16)34372-9.

DOI:10.1016/s1701-2163(16)34372-9

PMID:20085677

Abstract

OBJECTIVE

To compare maternal and neonatal outcomes after elective induction of labour and elective Caesarean section with outcomes after spontaneous labour in women with low-risk, full-term pregnancies.

METHODS

We extracted birth data from 1996 to 2005 from an obstetrical database. Singleton pregnancies with vertex presentation, anatomically normal, appropriately grown fetuses, and no medical or surgical complications were included. Outcomes after elective induction of labour and elective Caesarean section were compared with the outcomes after spontaneous labour, using chi-square and Student t tests and logistic regression.

RESULTS

A total of 9686 women met the study criteria(3475 nulliparous, 6211 multiparous). The incidence of unplanned Caesarean section was higher in nulliparous women undergoing elective induction than in those with spontaneous labour (P < 0.001). Postpartum complications were more common in nulliparous and multiparous women undergoing elective induction (P < 0.001 and P < 0.01, respectively) and multiparous women undergoing elective Caesarean section, (P < 0.001). Rates of triage in NICU were higher in nulliparous women undergoing elective Caesarean section (P < 0.01), and requirements for neonatal free-flow oxygen administration were higher in nulliparous and multiparous women undergoing elective Caesarean section (P < 0.01 for each). Unplanned Caesarean section was 2.7 times more likely in nulliparous women undergoing elective induction of labour (95% CI 1.74 to 4.28, P < 0.001) and was more common among nulliparous and multiparous women undergoing induction of labour and requiring cervical ripening (P < 0. 001 and P < 0.05, respectively).

CONCLUSION

Elective induction leads to more unplanned Caesarean sections in nulliparous women and to increased postpartum complications for both nulliparous and multiparous women. Elective Caesarean section has increased maternal and neonatal risks.

摘要

目的

比较低风险足月妊娠女性择期引产和择期剖宫产与自然分娩后的母婴结局。

方法

我们从一个产科数据库中提取了1996年至2005年的分娩数据。纳入单胎头先露、解剖结构正常、胎儿生长适宜且无内科或外科并发症的妊娠。使用卡方检验、学生t检验和逻辑回归，将择期引产和择期剖宫产的结局与自然分娩的结局进行比较。

结果

共有9686名女性符合研究标准（3475名初产妇，6211名经产妇）。择期引产的初产妇中计划外剖宫产的发生率高于自然分娩的初产妇（P<0.001）。择期引产的初产妇和经产妇（分别为P<0.001和P<0.01）以及择期剖宫产的经产妇中产后并发症更常见（P<0.001）。择期剖宫产的初产妇入住新生儿重症监护病房（NICU）的分诊率更高（P<0.01），择期剖宫产的初产妇和经产妇中新生儿使用自由流动氧气的需求更高（均为P<0.01）。择期引产的初产妇发生计划外剖宫产的可能性高2.7倍（95%可信区间1.74至4.28，P<0.001），并且在需要促宫颈成熟的引产初产妇和经产妇中更常见（分别为P<0.001和P<0.05）。