Cardozo L, Fysh J, Pearce J M
Br Med J (Clin Res Ed). 1986 Oct 25;293(6554):1059-63. doi: 10.1136/bmj.293.6554.1059.
A prospective trial was conducted to compare the effects of conservative management of prolonged pregnancy (conservative group) with routine induction of labour at 42 weeks' gestation (active group) in otherwise uncomplicated pregnancies. Of the 402 pregnancies studied, 207 (51%) were allocated to conservative management and 195 (49%) were allocated to have labour induced. The groups were well matched for age, parity, and smoking habits. One hundred and sixty six (80%) of the patients in the conservative group went into spontaneous labour. Of the remainder, two underwent elective caesarean section, 19 had labour induced because of clinical concern, and the remaining 20 had labour induced at the patient's own request. One hundred and twenty five (64%) of the patients in the planned active group underwent induction of labour. Of the remaining 70, 49 went into spontaneous labour and 21 (11%) asked that they should not have labour induced. Comparison of the two groups showed no difference in the length of the first stage of labour but a trend towards an increased need for intervention for fetal distress (p less than 0.06) in the active group. There were no differences in the length of the second stage, the need for intervention, or the mode of delivery. In terms of Apgar scores the neonatal outcome was not significantly different between the two groups, but a greater proportion of the babies (15% v 8%) in the active group required intubation. Umbilical cord venous pH estimated in the last 183 consecutive deliveries in the study showed a significantly lower mean value in the active group (p less than 0.05). There was no difference in birth weight between the two groups. Two deaths occurred in the study. There was a stillbirth in the conservative group at 292 days after massive abruption, and one neonatal death in the active group owing to multiple congenital abnormalities. The outcome for mother and baby in patients from both groups who went into spontaneous labour was generally good. The outcome for patients for whom conservative management was planned but induction became necessary was no different from that of patients who underwent planned induction at term. Thus from our results we can find no evidence to support the view that women with normal prolonged pregnancy should undergo routine induction of labour at 42 weeks' gestation.
进行了一项前瞻性试验，以比较在其他方面无并发症的妊娠中，延期妊娠保守治疗组（保守组）与妊娠42周常规引产组（积极组）的效果。在研究的402例妊娠中，207例（51%）被分配至保守治疗组，195例（49%）被分配进行引产。两组在年龄、产次和吸烟习惯方面匹配良好。保守组166例（80%）患者自然分娩。其余患者中，2例行选择性剖宫产，19例因临床担忧而引产，其余20例应患者自身要求引产。计划积极组125例（64%）患者接受引产。其余70例中，49例自然分娩，21例（11%）要求不进行引产。两组比较显示，第一产程长度无差异，但积极组胎儿窘迫干预需求有增加趋势（p<0.06）。第二产程长度、干预需求或分娩方式无差异。就阿氏评分而言，两组新生儿结局无显著差异，但积极组中需要插管的婴儿比例更高（15%对8%）。研究中连续183例分娩的脐静脉pH值显示，积极组平均数值显著更低（p<0.05）。两组出生体重无差异。研究中有2例死亡。保守组在严重胎盘早剥后292天有1例死产，积极组有1例新生儿因多发先天性畸形死亡。两组自然分娩患者的母婴结局总体良好。计划保守治疗但有必要引产的患者结局与足月计划引产患者无异。因此，从我们的结果中找不到证据支持正常延期妊娠女性应在妊娠42周常规引产的观点。
