From the Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2010 Sep;116(3):601-605. doi: 10.1097/AOG.0b013e3181eb6e9b.
To compare outcomes of labor between nulliparous women with a favorable cervix who underwent either elective labor induction or expectant management beyond 39 weeks of gestation.
A retrospective cohort study was conducted of nulliparous women with a singleton gestation who had a favorable cervix (modified Bishop score of at least 5) and delivered between 2006 and 2008. Two hundred ninety-four nulliparous women who underwent elective induction of labor between 39 and 40 5/7 weeks of gestation were compared with 294 nulliparous women who were expectantly managed beyond 39 weeks of gestation.
The primary outcome, cesarean delivery, was similar between the two groups (20.8% compared with 20.1%, respectively, P=.84), a result that did not change in multivariable analysis. There were also no significant differences in other maternal (eg, chorioamnionitis, meconium, operative vaginal delivery, third- and fourth-degree lacerations, postpartum hemorrhage), or neonatal (arterial cord pH less than 7.0, Apgar score less than 4 at 5 minutes, neonatal intensive care unit admission) outcomes. Women who underwent an elective labor induction did have longer duration in labor and delivery between admission and delivery (median 12.7 compared with 9.0 hours, P<.001).
For nulliparous women with a favorable cervix, elective labor induction has a similar chance of resulting in cesarean delivery as expectant management, although it appears to result in an increase in resource use.
II.
比较宫颈条件良好的初产妇行选择性引产或妊娠 39 周后期待管理的分娩结局。
对 2006 年至 2008 年期间宫颈条件良好（改良 Bishop 评分至少为 5 分）且单胎妊娠分娩的初产妇进行回顾性队列研究。将 294 例在 39~40 5/7 孕周行选择性引产的初产妇与 294 例妊娠 39 周后期待管理的初产妇进行比较。
主要结局（剖宫产）在两组间相似（分别为 20.8%和 20.1%，P=.84），多变量分析结果亦如此。其他母体结局（如绒毛膜羊膜炎、胎便、经阴道助产、Ⅲ度和Ⅳ度裂伤、产后出血）和新生儿结局（脐动脉血 pH 值<7.0、5 分钟时 Apgar 评分<4 分、新生儿重症监护病房入住）也无显著差异。行选择性引产的产妇其入院至分娩的产程和分娩时间更长（中位数分别为 12.7 小时和 9.0 小时，P<.001）。
对于宫颈条件良好的初产妇，选择性引产与期待管理的剖宫产几率相似，但似乎会增加资源的使用。
Ⅱ级。
