Wolfe Heather, Timofeev Julia, Tefera Eshetu, Desale Sameer, Driggers Rita W
Georgetown University School of Medicine, Washington, DC.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC.
Am J Obstet Gynecol. 2014 Jul;211(1):53.e1-5. doi: 10.1016/j.ajog.2014.01.034. Epub 2014 Jan 31.
The objective of the study was to examine maternal and neonatal outcomes in obese nulliparous women with an unfavorable cervix undergoing elective induction of labor compared with expectant management after 39.0 weeks.
This was a retrospective analysis of a cohort of nulliparous women with a vertex singleton gestation who delivered at MedStar Washington Hospital Center from 2007 to 2012. Patients with unfavorable cervix between 38.0 and 38.9 weeks (modified Bishop <5) and a body mass index of 30.0 kg/m(2) or greater at the time of delivery were included. Women undergoing elective induction between 39.0 and 40.9 weeks' gestation were compared with those who were expectantly managed beyond 39.0 weeks. Outcomes were analyzed using χ(2), Student t, or Wilcoxon rank sum tests as appropriate with a significance set at P < .05.
Sixty patients meeting inclusion criteria underwent elective induction of labor and were compared with 410 patients expectantly managed beyond 39.0 weeks. The rate of cesarean delivery was significantly higher in the electively induced group (40.0% vs 25.9%, respectively, P = .022). Other maternal outcomes, including operative vaginal delivery, rate of third- or fourth-degree lacerations, chorioamnionitis, postpartum hemorrhage, and a need for a blood transfusion were similar. The neonatal intensive care unit admission rate was higher in the electively induced group (18.3% vs 6.3%, P = .001). Birthweight, umbilical artery pH less than 7.0, and Apgar less than 7 at 5 minutes were similar.
Elective labor induction at term in obese nulliparous parturients carries an increased risk of cesarean delivery and higher neonatal intensive care unit admission rate as compared with expectant management.
本研究的目的是比较肥胖初产妇宫颈条件不佳时，在39.0周后进行择期引产与期待治疗的母婴结局。
这是一项对2007年至2012年在MedStar华盛顿医院中心分娩的初产妇单胎头位妊娠队列的回顾性分析。纳入在38.0至38.9周时宫颈条件不佳（改良Bishop评分<5）且分娩时体重指数为30.0kg/m²或更高的患者。将妊娠39.0至40.9周接受择期引产的妇女与妊娠39.0周后接受期待治疗的妇女进行比较。根据情况使用χ²检验、Student t检验或Wilcoxon秩和检验分析结局，显著性设定为P<.05。
60例符合纳入标准的患者接受了择期引产，并与410例妊娠39.0周后接受期待治疗的患者进行比较。择期引产组剖宫产率显著更高（分别为40.0%和25.9%，P=.022）。其他产妇结局，包括手术阴道分娩、三度或四度裂伤率、绒毛膜羊膜炎、产后出血以及输血需求相似。择期引产组新生儿重症监护病房入住率更高（18.3%对6.3%，P=.001）。出生体重、脐动脉pH值小于7.0以及5分钟时阿氏评分小于7相似。
与期待治疗相比,肥胖初产妇足月择期引产剖宫产风险增加，新生儿重症监护病房入住率更高。
