Center for Women's Reproductive Health and the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Obstet Gynecol. 2019 Aug;134(2):282-287. doi: 10.1097/AOG.0000000000003371.
To compare perinatal and maternal outcomes in low-risk multiparous women who underwent elective induction of labor in the 39th week of gestation with those who were expectantly managed.
We performed a single center retrospective cohort study of low-risk multiparous women delivering nonanomalous singletons between 39 and 42 completed weeks of gestation from 2014 to 2018. The primary outcome was a perinatal composite of death, neonatal respiratory support, a 5-minute Apgar score of 3 or less, and shoulder dystocia. Groups were compared using χ, Fisher exact, two sample t-test, and Wilcoxon rank sum tests, as appropriate. Multivariable logistic regression models were used to adjust for potential confounders.
Of the 3,703 low-risk multiparous women meeting inclusion criteria, 453 (12%) delivered between 39 0/7 and 39 4/7 after an elective induction of labor. Women who underwent elective induction of labor were more likely to be privately insured, non-Hispanic, and weigh more at their first prenatal visit (all P<.01) compared with expectant management. An elective induction of labor was associated with decreased frequency of the perinatal composite morbidity (4.0% vs 7.1%; adjusted odds ratio [aOR] 0.57, 95% CI 0.34-0.96) compared with expectant management. Fewer cesarean deliveries occurred among women in the elective induction of labor group (5.1% vs 6.6%; aOR 0.60, 95% CI 0.37-0.97). Other maternal outcomes (hypertensive disorders, chorioamnionitis, and operative vaginal deliveries) as well as neonatal intensive care unit admissions were not different between groups.
Elective induction of labor in low-risk multiparous women in the 39th week of gestation was associated with decreased perinatal morbidity and a lower frequency of cesarean delivery compared with expectant management.
比较 39 孕周行选择性引产的低危经产妇与期待治疗的产妇围生儿及母体结局。
我们对 2014 年至 2018 年在 39 至 42 周足月分娩非畸形单胎的低危经产妇进行了一项单中心回顾性队列研究。主要结局是围生儿复合结局，包括死亡、新生儿呼吸支持、5 分钟 Apgar 评分 3 分及以下和肩难产。使用 χ2、Fisher 确切检验、两样本 t 检验和 Wilcoxon 秩和检验比较组间差异，适当采用多变量逻辑回归模型校正潜在混杂因素。
符合纳入标准的 3703 例低危经产妇中，453 例（12%）行选择性引产，分娩孕周为 39 0/7 周至 39 4/7 周。与期待治疗相比，行选择性引产的产妇更可能为私人保险、非西班牙裔，且首次产前检查时体重更重（均 P<.01）。与期待治疗相比，选择性引产与围生儿复合发病率降低相关（4.0%比 7.1%；校正比值比[aOR]0.57，95%置信区间[CI]0.34-0.96）。选择性引产组的剖宫产率较低（5.1%比 6.6%；aOR 0.60，95%CI 0.37-0.97）。两组产妇的其他结局（高血压疾病、绒毛膜羊膜炎和经阴道分娩）和新生儿重症监护病房入院率无差异。
与期待治疗相比，39 孕周低危经产妇行选择性引产可降低围生儿发病率和剖宫产率。
