自然分娩与引产的单胎头位初产妇分娩方式及出生体重与结局的关系

Mode of delivery and outcomes by birth weight among spontaneous and induced singleton cephalic nulliparous labors.

作者信息

Walsh Jennifer M, Hehir Mark P, Robson Michael S, Mahony Rhona M

机构信息

National Maternity Hospital, Dublin, Ireland.

出版信息

Int J Gynaecol Obstet. 2015 Apr;129(1):22-5. doi: 10.1016/j.ijgo.2014.10.029. Epub 2014 Dec 24.

DOI:10.1016/j.ijgo.2014.10.029

PMID:25575424

Abstract

OBJECTIVE

To assess the effect of birth weight on mode of delivery among nulliparous women in a setting with no policy of elective induction for suspected macrosomia.

METHODS

In an observational study, data were assessed from nulliparous women with a single cephalic pregnancy of at least 37 weeks in spontaneous (Robson group 1) and induced (Robson group 2a) labor attending a hospital in Dublin, Ireland, between January 1, 2008, and December 31, 2009. The primary outcome measure was mode of delivery.

RESULTS

A total of 7528 nulliparous labors were included (4989 in group 1 and 2539 in group 2a). The cesarean section rate was 15.1% overall (n=1139), with 411 (8.2%) in group 1, and 728 (28.7%) in group 2a. Cesarean delivery rates rose with increasing birth weight in group 1, from 119 (6.3%) of 1886 infants weighing 3000-3499 g and 160 (8.5%) of 1892 weighing 3500-3999 g, to 19 (26.8%) of 71 weighing 4500-4999 g. Rates of cesarean delivery were significantly higher in induced labor (group 2a) for each birth-weight category, ranging from 202 (25.9%) of 781 weighing 3000-3499 g and 243 (27.0%) of 899 weighing 3500-3999 g, to 38 (48.1%) of 79 weighing 4500-4999 g (P<0.01 for all).

CONCLUSION

In a setting with standardized management of labor, birth weight remains a significant determinant of mode of delivery.

摘要

目的

在没有针对疑似巨大儿进行选择性引产政策的情况下，评估出生体重对初产妇分娩方式的影响。

方法

在一项观察性研究中，对2008年1月1日至2009年12月31日期间在爱尔兰都柏林一家医院自然分娩（罗布森组1）和引产（罗布森组2a）的单头位妊娠至少37周的初产妇数据进行了评估。主要结局指标是分娩方式。

结果

共纳入7528例初产妇分娩（组1有4989例，组2a有2539例）。总体剖宫产率为15.1%（n = 1139），组1为411例（8.2%），组2a为728例（28.7%）。组1中，剖宫产率随出生体重增加而上升，体重3000 - 3499g的1886例婴儿中有119例（6.3%），体重3500 - 3999g的1892例中有160例（8.5%），体重4500 - 4999g的71例中有19例（26.8%）。在每个出生体重类别中，引产（组2a）的剖宫产率显著更高，体重3000 - 3499g的781例中有202例（25.9%），体重3500 - 3999g的899例中有243例（27.0%），体重4500 - 4999g的79例中有38例（48.1%）（所有P<0.01）。