Proctor Anna, Marshall Paul
Women's Clinical Service Unit, St James' University Hospital, Delivery Suite, Level 5 Gledhow Wing, Beckett Street, Leeds LS9 7TF, United Kingdom.
Adult, Child and Mental Health Nursing Academic Unit, School of Healthcare, University of Leeds, Room G17, Baines Wing, LS2 9UT, United Kingdom.
Midwifery. 2017 Jul;50:246-252. doi: 10.1016/j.midw.2017.04.009. Epub 2017 Apr 25.
to investigate whether a change in the management of postmature pregnancy to earlier induction affects the length of labour and the induction process. Secondly, to assess the feasibility of the research process to inform a future larger study.
a change in management of postmature pregnancy in an NHS hospital in October 2013, from induction at 42 weeks gestation to induction between 41-42 weeks, provided an opportunity to conduct a retrospective analysis. Pre-existing data from the maternity database and casenotes were collected and primary outcomes analysed using the Mann-Whitney test and the Hodges-Lehman confidence interval for differences in medians.
a large city based tertiary referral hospital in the North of England.
125 women induced before the change in policy were compared with 309 women induced after the change.
primary outcomes were length of 1st and 2nd stage of labour, overall length of labour, length of induction to established labour and length of induction to birth.
the median overall length of labour for women induced at 42 weeks was 6.5hours, while for women induced at 41-42 weeks this was 5.2hours. The difference was not statistically significant (p=0.15, 95% CI for median difference -0.27 to 1.93hours) with a small effect size (Pearson's r=-0.08). The median length of induction to birth was 13.6hours for women induced at 42 weeks and 16.5hours for women induced at 41-42 weeks. This difference was also not statistically significant (p=0.14, 95% CI for median difference -7.25 to 1.20hours) with a small effect size (Pearson's r=-0.13).
This study demonstrated no statistically significant differences in length of labour and induction following a change in the management of postmature pregnancy to earlier induction. A large study is needed to establish definitively the effects of earlier induction on labour outcomes.
研究过期妊娠管理方式改为更早引产是否会影响产程长度和引产过程。其次，评估该研究过程对未来更大规模研究提供信息的可行性。
2013年10月，一家英国国民健康服务体系（NHS）医院对过期妊娠的管理方式进行了改变，从妊娠42周引产改为在41 - 42周之间引产，这提供了进行回顾性分析的机会。收集了产科数据库和病历中的现有数据，并使用曼 - 惠特尼检验以及中位数差异的霍奇斯 - 莱曼置信区间对主要结局进行分析。
英格兰北部一家大型城市的三级转诊医院。
将政策改变前引产的125名女性与改变后引产的309名女性进行比较。
主要结局为第一产程和第二产程的长度、总产程长度、引产至规律宫缩的时间以及引产至分娩的时间。
42周引产的女性总产程中位数为6.5小时，而41 - 42周引产的女性为5.2小时。差异无统计学意义（p = 0.15，中位数差异的95%置信区间为 - 0.27至1.93小时），效应量较小（皮尔逊相关系数r = - 0.08）。42周引产的女性引产至分娩的中位数时间为13.6小时，41 - 42周引产的女性为16.5小时。该差异也无统计学意义（p = 0.14，中位数差异的95%置信区间为 - 7.25至1.20小时），效应量较小（皮尔逊相关系数r = - 0.13）。
本研究表明，过期妊娠管理方式改为更早引产在产程长度和引产方面无统计学显著差异。需要进行大规模研究以明确更早引产对分娩结局的影响。
