Richards Jennifer L, Kramer Michael S, Deb-Rinker Paromita, Rouleau Jocelyn, Mortensen Laust, Gissler Mika, Morken Nils-Halvdan, Skjærven Rolv, Cnattingius Sven, Johansson Stefan, Delnord Marie, Dolan Siobhan M, Morisaki Naho, Tough Suzanne, Zeitlin Jennifer, Kramer Michael R
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
JAMA. 2016 Jul 26;316(4):410-9. doi: 10.1001/jama.2016.9635.
Clinicians have been urged to delay the use of obstetric interventions (eg, labor induction, cesarean delivery) until 39 weeks or later in the absence of maternal or fetal indications for intervention.
To describe recent trends in late preterm and early term birth rates in 6 high-income countries and assess association with use of clinician-initiated obstetric interventions.
Retrospective analysis of singleton live births from 2006 to the latest available year (ranging from 2010 to 2015) in Canada, Denmark, Finland, Norway, Sweden, and the United States.
Use of clinician-initiated obstetric intervention (either labor induction or prelabor cesarean delivery) during delivery.
Annual country-specific late preterm (34-36 weeks) and early term (37-38 weeks) birth rates.
The study population included 2,415,432 Canadian births in 2006-2014 (4.8% late preterm; 25.3% early term); 305,947 Danish births in 2006-2010 (3.6% late preterm; 18.8% early term); 571,937 Finnish births in 2006-2015 (3.3% late preterm; 16.8% early term); 468,954 Norwegian births in 2006-2013 (3.8% late preterm; 17.2% early term); 737,754 Swedish births in 2006-2012 (3.6% late preterm; 18.7% early term); and 25,788,558 US births in 2006-2014 (6.0% late preterm; 26.9% early term). Late preterm birth rates decreased in Norway (3.9% to 3.5%) and the United States (6.8% to 5.7%). Early term birth rates decreased in Norway (17.6% to 16.8%), Sweden (19.4% to 18.5%), and the United States (30.2% to 24.4%). In the United States, early term birth rates decreased from 33.0% in 2006 to 21.1% in 2014 among births with clinician-initiated obstetric intervention, and from 29.7% in 2006 to 27.1% in 2014 among births without clinician-initiated obstetric intervention. Rates of clinician-initiated obstetric intervention increased among late preterm births in Canada (28.0% to 37.9%), Denmark (22.2% to 25.0%), and Finland (25.1% to 38.5%), and among early term births in Denmark (38.4% to 43.8%) and Finland (29.8% to 40.1%).
Between 2006 and 2014, late preterm and early term birth rates decreased in the United States, and an association was observed between early term birth rates and decreasing clinician-initiated obstetric interventions. Late preterm births also decreased in Norway, and early term births decreased in Norway and Sweden. Clinician-initiated obstetric interventions increased in some countries but no association was found with rates of late preterm or early term birth.
临床医生被敦促在没有母体或胎儿干预指征的情况下，将产科干预措施（如引产、剖宫产）的使用推迟到39周或更晚。
描述6个高收入国家晚期早产和早期足月产率的近期趋势，并评估与临床医生发起的产科干预措施使用之间的关联。
对加拿大、丹麦、芬兰、挪威、瑞典和美国2006年至可获得的最新年份（2010年至2015年）的单胎活产进行回顾性分析。
分娩期间临床医生发起的产科干预措施（引产或临产前剖宫产）的使用情况。
各国特定年份的晚期早产（34 - 36周）和早期足月产（37 - 38周）率。
研究人群包括2006 - 2014年加拿大的2415432例分娩（4.8%为晚期早产；25.3%为早期足月产）；2006 - 2010年丹麦的305947例分娩（3.6%为晚期早产；18.8%为早期足月产）；2006 - 2015年芬兰的571937例分娩（3.3%为晚期早产；16.8%为早期足月产）；2006 - 2013年挪威的468954例分娩（3.8%为晚期早产；17.2%为早期足月产）；2006 - 2012年瑞典的737754例分娩（3.6%为晚期早产；18.7%为早期足月产）；以及200
