引产对剖宫产风险的影响：使用倾向评分控制混杂因素。
The effect of labour induction on the risk of caesarean delivery: using propensity scores to control confounding by indication.
机构信息
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, USA.
出版信息
BJOG. 2016 Aug;123(9):1521-9. doi: 10.1111/1471-0528.13682. Epub 2015 Sep 28.
OBJECTIVE
To use propensity score methods to control for confounding by indication in the association between labour induction and caesarean delivery.
DESIGN
Cross-sectional analysis of administrative hospital discharge data supplemented by medical record information.
SETTING
Fourteen US member hospitals of the National Perinatal Information Center.
SAMPLE
A cohort of 166 559 singleton liveborn deliveries in the period 2007-2012.
METHODS
We used propensity scores (PSs) to balance 83 covariates between induced and non-induced women, and compared estimates with traditional covariate adjustment. We estimated PSs for labour induction versus expectant management of pregnancy each week from 34 to 42 weeks of gestation. We estimated risk ratios (RRs) for the association between labour induction and primary caesarean delivery from models with no adjustment, traditional adjustment of five covariates, matched PS, and adjustment for continuous PS.
MAIN OUTCOME MEASURE
Caesarean delivery in current or subsequent week of gestation.
RESULTS
In crude models labour induction increased the risk of caesarean delivery in all weeks (RR 1.06-1.52), excepting 39 weeks of gestation (RR 0.89). After matching on PS, the analysis showed a significantly decreased risk of caesarean delivery with labour induction during weeks 35-39 (RR 0.77-0.92), and a significantly elevated risk at weeks 40 (RR 1.22) and 41 (RR 1.39). Traditional covariate and PS adjustment resulted in RRs between those from crude and PS-matched models.
CONCLUSIONS
There is evidence of considerable confounding by indication in the association of labour induction and caesarean delivery, particularly for preterm deliveries. Using PS methods, we found a reduced risk of caesarean delivery with labour induction before 40 weeks of gestation, and an elevated risk for weeks 40-42.
TWEETABLE ABSTRACT
With confounding adjustment, labour induction does not increase the risk of caesarean at 34-39 weeks of gestation.
目的
使用倾向评分方法控制指示性混杂因素，以研究引产与剖宫产之间的关联。
设计
对美国国家围产期信息中心的 14 家成员医院的行政出院数据进行横断面分析，并补充病历信息。
地点
美国国家围产期信息中心的 14 家成员医院。
样本
2007 年至 2012 年期间，166559 名单胎活产分娩的队列。
方法
我们使用倾向评分（PS）在诱导分娩和非诱导分娩的女性之间平衡 83 个协变量，并比较了传统协变量调整与估计值。我们每周从 34 周到 42 周对妊娠进行期待管理和引产，计算了引产与妊娠期待管理的 PS。我们使用无调整、传统五变量调整、匹配 PS 和连续 PS 调整的模型，估计了引产与主要剖宫产之间的风险比（RR）。
主要结局指标
当前或后续孕周的剖宫产。
结果
在未调整模型中，所有孕周的引产均增加了剖宫产的风险（RR 1.06-1.52），除了 39 孕周（RR 0.89）。在 PS 匹配后，分析显示 35-39 孕周期间引产的剖宫产风险显著降低（RR 0.77-0.92），而 40 孕周（RR 1.22）和 41 孕周（RR 1.39）的风险显著升高。传统协变量和 PS 调整后，RR 值在粗模型和 PS 匹配模型之间。
结论
在引产与剖宫产的关联中，存在明显的指示性混杂因素，尤其是在早产分娩中。使用 PS 方法，我们发现在 40 孕周之前引产可降低剖宫产的风险，而在 40-42 孕周时风险升高。
推文摘要
在混杂因素调整后，引产不会增加 34-39 孕周的剖宫产风险。
Zotero 插件