Allen Victoria M, Stewart Andrew, O'Connell Colleen M, Baskett Thomas F, Vincer Michael, Allen Alexander C
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS.
J Obstet Gynaecol Can. 2012 Apr;34(4):330-40. doi: 10.1016/s1701-2163(16)35213-6.
To estimate the influence of changing practice patterns of post-term induction of labour on severe neonatal morbidity.
This population-based cohort study used data from the Nova Scotia Atlee Perinatal Database to evaluate the effect of post-term induction of labour on stillbirth and neonatal mortality and severe neonatal morbidity in low-risk pregnancies. The study population included all pregnant women ≥ 40 weeks' gestation delivering in Nova Scotia from 1988 to 2008 who underwent induction of labour with a single fetus in cephalic presentation. Major congenital anomalies and pre-existing or severe gestational hypertension and diabetes were excluded. Women delivering post-term from 1994 to 2008 (after the Post-term Pregnancy Trial) were compared with women delivering from 1988 to 1992 to evaluate outcomes with changing maternal characteristics and obstetric practice patterns.
Evaluation and comparison of time epochs (1988 to 1992, 1994 to 1998, 1999 to 2003, and 2004 to 2008) demonstrated an increased risk for perinatal mortality or severe neonatal morbidity, especially low five-minute Apgar score, among both nulliparous and multiparous women. There were no significant differences in the risks for stillbirth or perinatal mortality over time. Comparable relationships were demonstrated in a subgroup of lower risk women.
The increase in post-term induction of labour with time is associated with a significant increase in severe neonatal morbidity, especially among infants born to multiparous women. Evaluation of the antepartum and intrapartum management of these low-risk pregnancies may provide additional information to reduce morbidity.
评估过期妊娠引产实践模式的变化对严重新生儿发病率的影响。
这项基于人群的队列研究使用了新斯科舍省阿特利围产期数据库的数据，以评估过期妊娠引产对低风险妊娠中的死产、新生儿死亡率和严重新生儿发病率的影响。研究人群包括1988年至2008年在新斯科舍省分娩的所有孕周≥40周、单胎头先露且接受引产的孕妇。排除主要先天性异常以及既往存在的或严重的妊娠期高血压和糖尿病。将1994年至2008年（在过期妊娠试验之后）过期分娩的妇女与1988年至1992年分娩的妇女进行比较，以评估随着孕产妇特征和产科实践模式的变化所产生的结局。
对不同时间段（1988年至1992年、1994年至1998年、1999年至2003年以及2004年至2008年）的评估和比较表明，初产妇和经产妇围产期死亡率或严重新生儿发病率的风险均增加，尤其是5分钟阿氏评分低的情况。随着时间推移，死产或围产期死亡率风险无显著差异。在低风险妇女亚组中也显示出类似关系。
随着时间的推移，过期妊娠引产的增加与严重新生儿发病率的显著增加相关，尤其是在经产妇所生婴儿中。对这些低风险妊娠的产前和产时管理进行评估可能会提供更多信息以降低发病率。
