Cundiff Geoffrey W, Simpson Mary Lynn, Koenig Nicole, Lee Terry
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC; Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, BC.
Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC.
J Obstet Gynaecol Can. 2017 May;39(5):354-360. doi: 10.1016/j.jogc.2017.01.003. Epub 2017 Mar 28.
To evaluate the safety of outpatient induction with dinoprostone insert in low-risk labour inductions for premature rupture of membranes or postdates gestation.
This retrospective cohort study compared outpatient labour induction priming with inpatient induction in terms of neonatal safety, mode of delivery, and obstetrical parameters. The sample included all inductions for premature rupture of membranes or postdate gestation. The analysis used logistic regression. The statistical power of the sample was 80% to detect a difference of 5.6% for the composite neonatal safety outcome (5-minute Apgar score <7 and NICU admission for >12 hours or transfer to a level III nursery).
Compared with the inpatient cohort (n = 568), the outpatient cohort (n = 611) included more postdate gestations (93% vs. 67%) with less cervical dilatation (0.5 cm vs. 1.0 cm) and larger infants (3705 g vs. 3551 g). There were no differences in measures of neonatal safety or mode of delivery. The outpatient cohort required more dinoprostone inserts (1.59 vs. 1.23) and were less likely to deliver within 24 hours (OR 0.24, 95% CI 0.17 to 0.34) but were also less likely to deliver by CS (OR 0.71, 95% CI 0.54 to 0.95), after adjusting for obstetrical parameters.
An outpatient model of labour induction using dinoprostone inserts is feasible and safe.
评估在胎膜早破或过期妊娠的低风险引产中使用地诺前列酮栓进行门诊引产的安全性。
这项回顾性队列研究比较了门诊引产启动与住院引产在新生儿安全性、分娩方式和产科参数方面的差异。样本包括所有胎膜早破或过期妊娠的引产病例。分析采用逻辑回归。样本的统计效能为80%，以检测复合新生儿安全结局（5分钟阿氏评分<7分且入住新生儿重症监护病房>12小时或转至三级新生儿重症监护室）5.6%的差异。
与住院队列（n = 568）相比，门诊队列（n = 611）中过期妊娠更多（93%对67%），宫颈扩张程度较小（0.5厘米对1.0厘米），婴儿体重较大（3705克对3551克）。在新生儿安全指标或分娩方式方面没有差异。在调整产科参数后，门诊队列需要更多的地诺前列酮栓（1.59对1.23），在24小时内分娩的可能性较小（比值比0.24，95%置信区间0.17至0.34），但剖宫产分娩的可能性也较小（比值比0.71，95%置信区间0.54至0.95）。
使用地诺前列酮栓进行门诊引产模式是可行且安全的。
