选择性足月引产与期待管理的比较：母婴结局。
Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes.
机构信息
Oregon Health & Science University, Portland, Oregon; the University of California, San Francisco, San Francisco, California; Penn State University College of Medicine, Hershey, Pennsylvania; Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; the Group Health Research Institute, Seattle, Washington; and Kaiser Permanente Southern California, Pasadena, California.
出版信息
Obstet Gynecol. 2013 Oct;122(4):761-769. doi: 10.1097/AOG.0b013e3182a6a4d0.
OBJECTIVE
To test the association of elective induction of labor at term compared with expectant management and maternal and neonatal outcomes.
METHODS
This was a retrospective cohort study of all deliveries without prior cesarean delivery in California in 2006 using linked hospital discharge and vital statistics data. We compared elective induction at each term gestational age (37-40 weeks) as defined by The Joint Commission with expectant management in vertex, nonanomalous, singleton deliveries. We used multivariable logistic regression to test the association of elective induction and cesarean delivery, operative vaginal delivery, maternal third- or fourth-degree lacerations, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, hyperbilirubinemia, and macrosomia (birth weight greater than 4,000 g) at each gestational week, stratified by parity.
RESULTS
The cesarean delivery rate was 16%, perinatal mortality was 0.2%, and neonatal intensive care unit admission was 6.2% (N=362,154). The odds of cesarean delivery were lower among women with elective induction compared with expectant management across all gestational ages and parity (37 weeks [odds ratio (OR) 0.44, 95% confidence interval (CI) 0.34-0.57], 38 weeks [OR 0.43, 95% CI 0.38-0.50], 39 weeks [OR 0.46, 95% CI 0.41-0.52], 40 weeks [OR 0.57, CI 0.50-0.65]). Elective induction was not associated with increased odds of severe lacerations, operative vaginal delivery, perinatal death, neonatal intensive care unit admission, respiratory distress, shoulder dystocia, or macrosomia at any term gestational age. Elective induction was associated with increased odds of hyperbilirubinemia at 37 and 38 weeks of gestation and shoulder dystocia at 39 weeks of gestation.
CONCLUSION
Elective induction of labor is associated with decreased odds of cesarean delivery when compared with expectant management.
LEVEL OF EVIDENCE
: II.
目的
检验足月时选择性引产与期待管理以及母婴结局的关联。
方法
这是一项回顾性队列研究，纳入了 2006 年加利福尼亚州所有初次剖宫产分娩之外的产妇，使用医院出院和生命统计数据进行关联。我们将由联合委员会定义的每个足月妊娠（37-40 周）的选择性引产与头位、非畸形、单胎的期待管理进行比较。我们使用多变量逻辑回归检验选择性引产与剖宫产、经阴道分娩、产妇三度或四度裂伤、围产儿死亡、新生儿重症监护病房（NICU）收治、呼吸窘迫、肩难产、高胆红素血症和巨大儿（出生体重＞4000g）的关联，按产次分层，分析每个妊娠周的结果。
结果
剖宫产率为 16%，围产儿死亡率为 0.2%，NICU 收治率为 6.2%（N=362154）。与期待管理相比，所有妊娠周和产次的选择性引产妇女剖宫产的可能性均较低（37 周[比值比（OR）0.44，95%置信区间（CI）0.34-0.57]、38 周[OR 0.43，95% CI 0.38-0.50]、39 周[OR 0.46，95% CI 0.41-0.52]、40 周[OR 0.57，95% CI 0.50-0.65]）。选择性引产与严重裂伤、经阴道分娩、围产儿死亡、NICU 收治、呼吸窘迫、肩难产或任何足月妊娠时的巨大儿的可能性增加无关。选择性引产与 37 周和 38 周时高胆红素血症以及 39 周时肩难产的可能性增加有关。
结论
与期待管理相比，选择性引产与剖宫产的可能性降低相关。
证据质量
II 级。
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