Kjeldsen Louise L, Sindberg Mette, Maimburg Rikke D
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark.
Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
Midwifery. 2015 May;31(5):526-31. doi: 10.1016/j.midw.2015.02.003. Epub 2015 Feb 12.
to evaluate a change of guideline for earlier induction of labour in post term pregnancies and its possible impact on selected birth interventions and outcome of the newborn.
a historical cohort study.
Department of Obstetrics at Aarhus University Hospital in Denmark.
18,247 women giving birth between 1 January 2009 and 12 December 2012.
to compare induction of labour in two consecutive time periods before and after implementation of a new guideline on induction of labour (42 weeks versus 41 weeks plus five days gestational age) in post term pregnancy. t-Test and χ(2) were used to calculate means of gestational age and relative risk (RR) of selected birth and newborn outcomes. Stratification by Mantel-Haenszel-analysis was used to adjust for possible confounders. Robson׳s classification system 'Ten Group Classification System' was used to create comparable groups within the performed analysis.
a difference in means of three gestational days after implementation of the new guideline on earlier induction of labour was found together with an overall unadjusted decrease in emergency caesarean section rate of 30% (RR 0.70, 95% CI; 0.54-0.91). Stratified analysis on parity showed a reduction in emergency caesarean section but only in nulliparous women (RR 0.78, 95% CI; 0.66-0.92), whereas the analysis in multiparous women showed a non-statistically significant increased risk of emergency caesarean section (RR 1.39, 95% CI; 0.89-2.18). No differences were found in assisted vaginal childbirths and outcome in newborns concerning Apgar score, pH and standard base excess in women induced in 42 weeks versus 41 weeks plus five days gestational age.
the findings of this study suggest that earlier induction of labour due to post term pregnancy has a positive influence, but only in nulliparous women, by lowering the risk of emergency caesarean section evidently without increasing the risk on adverse outcome in newborns.
评估过期妊娠时提前引产指南的变化及其对选定的分娩干预措施和新生儿结局的可能影响。
一项历史性队列研究。
丹麦奥胡斯大学医院妇产科。
2009年1月1日至2012年12月12日期间分娩的18247名妇女。
比较过期妊娠中实施新的引产指南（孕42周与孕41周加5天）前后两个连续时间段的引产情况。采用t检验和χ²检验计算孕周均值以及选定分娩和新生儿结局的相对风险（RR）。使用Mantel-Haenszel分层分析来调整可能的混杂因素。在进行的分析中，使用罗布森分类系统“十组分类系统”创建可比组。
实施新的提前引产指南后，孕周均值相差3天，同时急诊剖宫产率总体未经调整降低了30%（RR 0.70，95%CI：0.54 - 0.91）。按产次分层分析显示，急诊剖宫产率降低，但仅在初产妇中（RR 0.78，95%CI：0.66 - 0.92），而经产妇分析显示急诊剖宫产风险增加，但无统计学意义（RR 1.39，95%CI：0.89 - 2.18）。在孕42周与孕41周加5天引产的妇女中，辅助阴道分娩以及新生儿结局在阿氏评分、pH值和标准碱剩余方面未发现差异。
本研究结果表明，过期妊娠提前引产有积极影响，但仅对初产妇而言，可显著降低急诊剖宫产风险，且不增加新生儿不良结局风险。
