Kuper Spencer G, Sievert Rachel A, Steele Robin, Biggio Joseph R, Tita Alan T, Harper Lorie M
University of Alabama at Birmingham, Center for Women's Reproductive Health, Birmingham, Alabama.
Obstet Gynecol. 2017 Nov;130(5):1143-1151. doi: 10.1097/AOG.0000000000002320.
To compare maternal and neonatal outcomes in women who underwent induction of labor or planned cesarean delivery in indicated preterm births before 34 weeks of gestation.
We conducted a retrospective cohort study of all indicated singleton preterm births (23-34 weeks of gestation) in a tertiary center from 2011 to 2014. The primary maternal outcome was a composite of early postpartum hemorrhage, blood transfusion, operative complications, postpartum complications, and clinical chorioamnionitis. The primary neonatal outcome was a composite of neonatal death, cardiopulmonary resuscitation in the delivery room, grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, culture-proven sepsis, birth trauma, arterial cord gas pH less than 7 or base excess less than -12, and 5-minute Apgar score 3 or less. Outcomes were compared by intended mode of delivery (induction of labor compared with cesarean) and adjusted for confounders. In secondary analyses, maternal and neonatal outcomes based on the intended mode of delivery were stratified by gestational age (23-27 6/7, 28-31 6/7, and 32-33 6/7 weeks of gestation).
Of 629 patients with indicated early preterm births during the study period, 331 (53%) underwent induction of labor, of whom 208 (63%) delivered vaginally. Induction of labor was not associated with an increased risk of the primary maternal (16.3% compared with 19.5%, adjusted odds ratio [OR] 0.8, 95% CI 0.5-1.3) or neonatal composite outcome (14.5% compared with 35.9%, adjusted OR 0.7, 95% CI 0.4-1.1). Analyses stratified by gestational age were consistent with the overall analysis.
Maternal and neonatal outcomes do not differ based on the intended mode of delivery. Induction of labor should be considered when early preterm birth is indicated.
比较妊娠34周前指征性早产孕妇引产与计划剖宫产的母婴结局。
我们对2011年至2014年在一家三级医疗中心所有指征性单胎早产（妊娠23 - 34周）进行了一项回顾性队列研究。主要孕产妇结局是产后早期出血、输血、手术并发症、产后并发症和临床绒毛膜羊膜炎的综合情况。主要新生儿结局是新生儿死亡、产房心肺复苏、3级或4级脑室内出血、坏死性小肠结肠炎、血培养证实的败血症、产伤、脐动脉血气pH值小于7或碱剩余小于 - 12以及5分钟阿氏评分3分及以下的综合情况。根据预期分娩方式（引产与剖宫产）比较结局，并对混杂因素进行校正。在二次分析中，根据预期分娩方式的母婴结局按孕周（妊娠23 - 27⁶/₇周、28 - 31⁶/₇周和32 - 33⁶/₇周）进行分层。
在研究期间629例指征性早期早产患者中，331例（53%）接受了引产，其中208例（63%）经阴道分娩。引产与主要孕产妇综合结局风险增加无关（分别为16.3%和19.5%，校正比值比[OR] 0.8，95%可信区间[CI] 0.5 - 1.3），也与主要新生儿综合结局风险增加无关（分别为14.5%和35.9%，校正OR 0.7，95% CI 0.4 - 1.1）。按孕周分层的分析与总体分析一致。
根据预期分娩方式，母婴结局无差异。指征性早期早产时应考虑引产。
