引产术后剖宫产的风险：医院之间有差异吗？

Risk of caesarean section after induced labour: do hospitals make a difference?

作者信息

Teixeira Cristina, Correia Sofia, Barros Henrique

机构信息

Institute of Public Health, University of Porto, Porto, Portugal.

出版信息

BMC Res Notes. 2013 May 28;6:214. doi: 10.1186/1756-0500-6-214.

DOI:10.1186/1756-0500-6-214

PMID:23714240

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3668278/

Abstract

BACKGROUND

There is a well-known relationship between induced labour and caesarean rates. However, it remains unknown whether this relationship reflects the impact of more complex obstetric conditions or the variability in obstetric practices. We sought to quantify the independent role of the hospital as a variable that can influence the occurrence of caesarean section after induced labour.

METHODS

As part of the Portuguese Generation XXI birth cohort, we evaluated 2041 consecutive women who underwent singleton pregnancies with labour induction, at five public level III obstetric units (April 2005-August 2006). The indications for induction were classified according to the guidelines of the American and the Royal Colleges of Obstetricians and Gynaecologists. Poisson regression models were adjusted to estimate the association between the hospital and surgical delivery after induction. Crude and adjusted prevalence ratios (PR) and a 95% confidence interval (95% CI) were computed.

RESULTS

The proportion of women who were induced without formal clinical indications varied among hospitals from 20.3% to 45.5% (p<0.001). After adjusting for confounders, the risk of undergoing a caesarean section after induced labour remained significantly different between the hospitals, for the cases in which there was no evident indication for induction [the highest PR reaching 1.86 (95% CI, 1.23-2.82)] and also when at least one such indication was present [1.53 (95% CI, 1.12-2.10)]. This pattern was also observed among the primiparous cephalic term induced women [the highest PR reaching 2.06 (95% CI, 1.23-2.82) when there was no evident indication for induction and 1.61 (95% CI, 1.11-2.34) when at least one such indication was present].

CONCLUSIONS

Caesarean section after induced labour varied significantly across hospitals where similar outcomes were expected. The effect was more evident when the induction was not based on the unequivocal presence of commonly accepted indications.

摘要

背景

引产与剖宫产率之间存在一种广为人知的关系。然而，这种关系是反映了更复杂产科情况的影响还是产科实践的变异性仍不清楚。我们试图量化医院作为一个可影响引产术后剖宫产发生的变量的独立作用。

方法

作为葡萄牙二十一世纪出生队列研究的一部分，我们评估了在五个公立三级产科单位（2005年4月至2006年8月）连续进行单胎妊娠引产的2041名妇女。引产指征根据美国和皇家妇产科学院的指南进行分类。采用泊松回归模型来估计医院与引产术后手术分娩之间的关联。计算粗患病率比（PR）和调整后的患病率比以及95%置信区间（95%CI）。

结果

在无正式临床指征情况下引产的妇女比例在各医院之间从20.3%至45.5%不等（p<0.001）。在对混杂因素进行调整后，对于无明显引产指征的病例，引产术后进行剖宫产的风险在各医院之间仍存在显著差异[最高PR达到1.86（95%CI，1.23 - 2.82）]，在存在至少一项此类指征时也是如此[1.53（95%CI, 1.12 - 2.10）]。在初产头位足月引产的妇女中也观察到了这种模式[无明显引产指征时最高PR达到2.06（95%CI，1.23 - 2.82），存在至少一项此类指征时为1.61（95%CI，1.11 - 2.34）]。