Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0526, USA.
Am J Obstet Gynecol. 2011 Oct;205(4):346.e1-4. doi: 10.1016/j.ajog.2011.05.004. Epub 2011 Jun 25.
The purpose of this study was to compare labor induction and cesarean delivery rates at term in community vs university hospitals.
A population-based retrospective cohort study of births was performed. Primary outcomes were term gestation at <39 weeks, labor induction, and cesarean delivery. After we adjusted for comorbidities, malpresentation, and previous cesarean delivery, logistic regression assessed the association between hospital type and primary outcomes.
Births occur less often in week 37 (n = 24390 [11%] vs 4006 [13%]; adjusted odds ratio [OR], 0.9; 95% confidence interval [CI], 0.8-0.9) and are similar in week 38 in community vs university hospitals. Inductions occur more commonly in community vs university settings at 37 weeks (n = 6440 [27%] vs 757 [19%]; adjusted OR, 1.7; 95% CI, 1.5-1.8) and at 38 weeks (n = 16586 [31%] vs 1530 [21%]; adjusted OR, 1.8; 95% CI, 1.7-1.9). Cesarean rates are no different between hospital types.
Induction is 70-80% more likely at community vs university hospitals before the optimal gestational age of ≥ 39 weeks, but cesarean delivery rates do not differ at term.
本研究旨在比较社区医院和大学医院足月时的引产和剖宫产率。
进行了一项基于人群的回顾性队列研究。主要结局是<39 周的足月妊娠、引产和剖宫产。在调整了合并症、胎位不正和既往剖宫产的情况后，采用 logistic 回归评估了医院类型与主要结局之间的关系。
第 37 周的分娩次数较少（n=24390[11%]比 4006[13%]；调整后的优势比[OR]，0.9；95%置信区间[CI]，0.8-0.9），而社区医院和大学医院在第 38 周的分娩次数相似。37 周时，社区医院的引产率高于大学医院（n=6440[27%]比 757[19%]；调整后的 OR，1.7；95% CI，1.5-1.8），38 周时，社区医院的引产率高于大学医院（n=16586[31%]比 1530[21%]；调整后的 OR，1.8；95% CI，1.7-1.9）。两种医院类型的剖宫产率没有差异。
在最佳妊娠年龄≥39 周之前，社区医院的引产率比大学医院高 70-80%，但足月时的剖宫产率没有差异。
