Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2019 Apr;36(5):449-454. doi: 10.1055/s-0038-1675331. Epub 2018 Nov 5.
We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m) undergoing induction of labor.
This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates.
Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21-3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47-6.58) only in nulliparous women.
Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.
我们旨在评估肥胖症 III 级（体重指数≥40kg/m²）孕妇行引产时，早期羊膜穿刺术对妊娠结局的影响。
这是一项回顾性队列研究，纳入了 2007 年 1 月至 2013 年 2 月期间行足月引产的肥胖症 III 级孕妇。早期羊膜穿刺术定义为宫颈扩张小于 4cm 时进行人工胎膜破裂。主要结局为剖宫产。次要结局包括产程时间、产妇复合发病率和新生儿复合发病率。亚组分析检查了产次的影响。多变量逻辑回归用于调整协变量。
在符合纳入标准的 285 名孕妇中，107 名（37.5%）行早期羊膜穿刺术，178 名（62.5%）行晚期羊膜穿刺术。多变量调整后，早期羊膜穿刺术与剖宫产相关（调整后的优势比[aOR]，2.05；95%置信区间[CI]，1.21-3.47）。两组间产程时间或产妇和新生儿发病率无显著差异。按产次分层时，早期羊膜穿刺术仅在初产妇中与剖宫产增加相关（aOR，3.10；95% CI，1.47-6.58）。
肥胖症 III 级孕妇，尤其是初产妇，行引产时行早期羊膜穿刺术可能与剖宫产风险增加相关。
