Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
Semin Perinatol. 2012 Oct;36(5):336-43. doi: 10.1053/j.semperi.2012.04.016.
Approximately 1 in 4 women in the United States are induced, with up to 1 in 10-12 being induced for elective reasons. National guidelines by the American College of Obstetricians and Gynecologists, the Society of Obstetricians Gynaecologists of Canada, and the Royal College of Obstetricians and Gynaecologists list 21 indications for inductions; however, all 3 concur in only 14% women (3 of 21). An induction should be considered appropriate if it meets the following 4 criteria: (1) concordant with women's autonomous informed decisions and desideratum; (2) optimizes maternal-fetal outcomes, including psychological maternal well-being; (3) congruous with evidence-based medicine; and (4) cost-effective. A meta-analysis of 22 randomized trials noted that membrane sweeping reduces the likelihood of induction. Implementing policies to prevent elective induction at 37-38 weeks provides conflicting results about the rate of macrosomia and stillbirth at early term. We argue that a well-designed randomized controlled trial, with adequate power to demonstrate whether prohibiting elective induction increases the rate of stillbirth or complications such as macrosomia, is warranted. Patient education during their prenatal course is a promising strategy to decrease the rate of induction.
大约每 4 名美国妇女中就有 1 人接受诱导分娩，其中多达每 10-12 人是出于选择性原因接受诱导分娩。美国妇产科医师学会、加拿大妇产科医师学会和皇家妇产科医师学院的国家指南列出了 21 种引产指征；然而，这三个组织仅在 14%的女性（21 人中的 3 人）中达成共识。如果符合以下 4 个标准，引产就应该被认为是合适的：（1）与妇女自主知情决策和愿望相一致；（2）优化母婴结局，包括产妇的心理健康；（3）符合循证医学；（4）具有成本效益。一项对 22 项随机试验的荟萃分析指出，胎膜早破可降低引产的可能性。实施防止 37-38 周选择性引产的政策对早期足月产巨大儿和死产的发生率提供了相互矛盾的结果。我们认为，有必要进行一项设计良好的随机对照试验，以充分证明禁止选择性引产是否会增加死产或巨大儿等并发症的发生率。在产前过程中对患者进行教育是降低引产率的一个有前途的策略。
