Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Third Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Ultrasound Obstet Gynecol. 2019 Jan;53(1):26-35. doi: 10.1002/uog.20140. Epub 2018 Dec 7.
The rate of maternal and perinatal complications increases after 39 weeks' gestation in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the available evidence on the effect of elective induction of labor at 39 weeks on the risk of Cesarean section, and on maternal and perinatal outcomes.
PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases were searched from inception to August 2018. Additionally, the references of retrieved articles were searched. Eligible studies were randomized controlled trials of singleton uncomplicated pregnancies in which participants were randomized between 39 + 0 and 39 + 6 gestational weeks to either induction of labor or expectant management. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed according to the GRADE guideline. Primary outcomes included Cesarean section, maternal death and admission to the neonatal intensive care unit (NICU). Secondary outcomes included operative delivery, Grade-3/4 perineal laceration, postpartum hemorrhage, maternal infection, hypertensive disease of pregnancy, maternal thrombotic events, length of maternal hospital stay, neonatal death, need for neonatal respiratory support, cerebral palsy, length of stay in NICU and length of neonatal hospital stay. Pooled risk ratios (RRs) were calculated using random-effects models.
The meta-analysis included five studies (7261 cases). Induction of labor was associated with a decreased risk for Cesarean section (moderate quality of evidence; RR 0.86 (95% CI, 0.78-0.94); I = 0.1%), maternal hypertension (moderate quality of evidence; RR 0.65 (95% CI, 0.57-0.75); I = 0%) and neonatal respiratory support (moderate quality of evidence; RR 0.73 (95% CI, 0.58-0.95); I = 0%). Neonates born after induction weighed, on average, 81 g (95% CI, 63-100 g) less than those born after expectant management. No significant effects were found for the other outcomes with the available data. The main limitation of our analysis was that the majority of data were derived from a single large study. A second limitation arose from the open-label design of the studies, which may theoretically have affected the readiness of the attending clinician to resort to Cesarean section.
Elective induction of labor in uncomplicated singleton pregnancy at 39 weeks' gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
在未经选择的和复杂的妊娠中，39 周后产妇和围产儿并发症的发生率增加。本研究的目的是定量综合现有证据，评估选择性在 39 周行引产对剖宫产、产妇和围产儿结局的影响。
从建库至 2018 年 8 月，检索了 PubMed、美国临床试验注册处、SCOPUS 和 CENTRAL 数据库，并检索了已检索文献的参考文献。纳入的研究为随机对照试验，研究对象为单胎、无并发症的妊娠，参与者在 39+0 至 39+6 孕周之间随机分为引产组或期待管理组。使用 Cochrane 偏倚风险工具评估单个研究的偏倚风险。根据 GRADE 指南评估证据的总体质量。主要结局包括剖宫产、产妇死亡和入住新生儿重症监护病房（NICU）。次要结局包括经阴道分娩、3/4 级会阴裂伤、产后出血、产妇感染、妊娠高血压疾病、产妇血栓事件、产妇住院时间、新生儿死亡、需要新生儿呼吸支持、脑瘫、NICU 入住时间和新生儿住院时间。使用随机效应模型计算汇总风险比（RR）。
meta 分析纳入了 5 项研究（7261 例）。引产与剖宫产风险降低相关（中等质量证据；RR 0.86（95%CI，0.78-0.94）；I²=0.1%）、产妇高血压（中等质量证据；RR 0.65（95%CI，0.57-0.75）；I²=0%）和新生儿呼吸支持（中等质量证据；RR 0.73（95%CI，0.58-0.95）；I²=0%）。与期待管理相比，引产组新生儿出生时平均体重轻 81g（95%CI，63-100g）。利用现有数据，其他结局未发现有显著影响。我们分析的主要局限性是大多数数据来自一项大型研究。第二个局限性来自于研究的开放性标签设计，理论上这可能会影响主治医生选择剖宫产的意愿。
在 39 孕周时对无并发症的单胎妊娠进行选择性引产不会导致产妇或围产儿并发症，并且可能降低剖宫产、妊娠高血压疾病和新生儿呼吸支持的需求。版权所有 © 2018 ISUOG。由 John Wiley & Sons Ltd 出版。
