Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Am J Perinatol. 2019 Jan;36(1):45-52. doi: 10.1055/s-0038-1648228. Epub 2018 May 3.
This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management.
This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates.
Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission.
In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.
本文比较了≥35 岁且无医学指征行引产（NMII）与期待管理的产妇和新生儿结局。
这是一项回顾性队列研究，纳入了年龄≥35 岁、单胎头位足月分娩的初产妇。比较了 37、38、39 和 40 孕周行 NMII 与该周期待管理的产妇结局。通过调整比值比（aOR）及其 95%置信区间（95%CI），控制了预设协变量。
在 3819 名年龄≥35 岁的初产妇中，1409 名（36.9%）行 NMII。总体而言，在 39 孕周或之后，NMII 的母婴结局相似或改善。在 37、38 和 39 孕周，与期待管理相比，NMII 与 37、38 和 39 孕周剖宫产的几率降低相关。在 40 孕周，与期待管理相比，NMII 与经阴道分娩的几率增加和新生儿重症监护病房（NICU）入住的几率降低相关。
在≥35 岁的初产妇中，与期待管理相比，NMII 与 37 至 39 孕周剖宫产的几率降低和 40 孕周 NICU 入住的几率降低相关。
