*Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN †Children's Hospital of Philadelphia, Philadelphia, PA.
Med Care. 2014 Jul;52(7):649-57. doi: 10.1097/MLR.0000000000000153.
There is increasing attention to labor induction and cesarean delivery occurring at 37 0/7-38 6/7 weeks' gestation (early-term) without medical indication.
To measure prevalence, change over time, patient characteristics, and infant outcomes associated with early-term nonindicated births.
Retrospective analysis using linked hospital discharge and birth certificate data for the 7,296,363 uncomplicated births (>37 0/7 wk' gestation) between 1995 and 2009 in 3 states.
Early-term nonindicated birth is calculated using diagnosis codes and birth certificate records. Secondary outcomes included infant prolonged length of stay and respiratory distress.
Across uncomplicated term births, the early-term nonindicated birth rate was 3.18%. After adjustment, the risk of nonindicated birth before 39 0/7 weeks was 86% higher in 2009 than in 1995 [hazard ratio (HR)=1.86; 95% confidence interval (CI), 1.81-1.90], peaking in 2006 (HR=2.03; P<0.001). Factors independently associated with higher odds included maternal age, higher education levels, private health insurance, and delivering at smaller-volume or nonteaching hospitals. Black women had higher risk of nonindicated cesarean birth (HR=1.29; 95% CI, 1.27-1.32), which was associated with greater odds of prolonged length of stay [adjusted odds ratio (AOR)=1.60; 95% CI, 1.57-1.64] and infant respiratory distress (AOR=2.44; 95% CI, 2.37-2.50) compared with births after 38 6/7 weeks. Early-term nonindicated induction was also associated with comparatively greater odds of prolonged length of stay (AOR=1.20; 95% CI, 1.17-1.23).
Nearly 4% of all uncomplicated births to term infants occurred before 39 0/7 weeks' gestation without medical indication. These births were associated with adverse infant outcomes.
越来越多的人关注在没有医学指征的情况下，于 37 0/7-38 6/7 孕周（早期足月）行引产和剖宫产。
测量与无医学指征的早期足月分娩相关的流行率、随时间的变化、患者特征和婴儿结局。
使用 1995 年至 2009 年在 3 个州的 7296363 例无并发症分娩（>37 0/7 孕周）的医院出院和出生证明数据进行回顾性分析。
使用诊断代码和出生证明记录计算早期足月无指征分娩。次要结局包括婴儿延长住院时间和呼吸窘迫。
在所有无并发症的足月分娩中，早期足月无指征分娩率为 3.18%。调整后，2009 年与 1995 年相比，39 0/7 周前无指征分娩的风险增加了 86%（危险比[HR]=1.86；95%置信区间[CI]，1.81-1.90），在 2006 年达到高峰（HR=2.03；P<0.001）。与更高的可能性相关的独立因素包括产妇年龄、更高的教育水平、私人医疗保险以及在较小容量或非教学医院分娩。黑人妇女行无指征剖宫产的风险更高（HR=1.29；95%CI，1.27-1.32），与延长住院时间的可能性更大相关（校正比值比[AOR]=1.60；95%CI，1.57-1.64）和婴儿呼吸窘迫（AOR=2.44；95%CI，2.37-2.50）相比，在 38 6/7 周后分娩。早期足月无指征引产也与延长住院时间的可能性更大相关（AOR=1.20；95%CI，1.17-1.23）。
近 4%的所有足月婴儿的无并发症分娩发生在没有医学指征的情况下，在 39 0/7 周前。这些分娩与婴儿不良结局相关。
