Center of Research in Epidemiology and Statistics (CRESS), INSERM, National Institute for Agricultural Research (INRA), Université de Paris, Paris, France.
Department of Obstetrics and Gynecology, AP-HP, Louis Mourier Hospital, Université de Paris, Colombes, France.
Acta Obstet Gynecol Scand. 2020 Mar;99(3):406-412. doi: 10.1111/aogs.13751. Epub 2019 Nov 19.
Great variations in cesarean rates after induction of labor exist and reasons for these disparities remain unclear. They may be explained by individual characteristics or obstetric practices. Ten-group classification systems have proved their utility to monitor cesarean rates in general population. We aimed to identify groups of women that account for most cesareans after induction of labor using the Nippita reproducible 10-group classification, specifically designed for induced population.
A prospective population-based cohort study was performed in 94 French maternity units, including 3042 women undergoing induction of labor. Women were sorted according to 10 mutually exclusive groups based on parity, weeks of gestation, number of fetuses, fetal presentation and previous cesarean delivery. Relative size, cesarean delivery rate and contribution to the overall cesarean rate were described for each group. Cesarean rates were compared according to the Bishop score at the onset of labor induction. Indications for cesarean delivery were also described in the groups that contributed most to the overall cesarean rate. The MEDIP protocol was registered in ClinicalTrial (NCT02477085).
The overall cesarean rate was 21.0% among this population of induced women. Nulliparous women with a term singleton cephalic fetus (groups 1, 2 and 3; at 37-38, 39-40 and ≥41 weeks of gestation, respectively) accounted for two-thirds of the overall cesarean rate because they were the largest group (relative size of 10.6, 16.6 and 18.1%, respectively) and had higher cesarean rates (27.2, 30.9 and 33.0%, respectively). When the Bishop score was <6 (n = 2270/3042), cesarean delivery rates were higher (24.1 vs 10.7% if Bishop score ≥6, P < 0.01), in particular for group 1 (29.1 vs 12.5%, P = 0.02), and group 2 (33.3 vs 19.3%, P = 0.01). In groups 1, 2 and 3, which contributed most to the overall cesarean rate, a significant part of the cesareans were performed before 6 cm of cervical dilation for dystocia only (40.0, 16.7 and 17.6%, respectively).
Nulliparous women with a term singleton cephalic fetus and an unfavorable cervix represent the population to target for auditing induction practices. Specific actions could be implemented among this population to weigh the benefits and risks of induction and improve the management of labor induction.
在引产之后，剖宫产率存在很大差异，其原因尚不清楚。这些差异可能可以用个体特征或产科实践来解释。十组分类系统已被证明可用于监测一般人群中的剖宫产率。我们旨在使用专门为引产人群设计的 Nippita 可再现的十组分类法，确定导致引产术后剖宫产率较高的人群。
这是一项在法国 94 家产科单位进行的前瞻性基于人群的队列研究，包括 3042 名接受引产的妇女。根据产次、孕周、胎儿数、胎儿先露和既往剖宫产，将妇女分为 10 个互斥组。描述了每个组的相对大小、剖宫产率和对总剖宫产率的贡献。根据产程开始时的 Bishop 评分比较剖宫产率。还描述了在导致总剖宫产率较高的组中剖宫产的指征。MEDIP 方案已在 ClinicalTrials 注册（NCT02477085）。
在这群接受引产的妇女中，总体剖宫产率为 21.0%。足月单胎头位（第 1、2 和 3 组；分别在 37-38、39-40 和≥41 孕周）的初产妇占总剖宫产率的三分之二，因为她们是最大的组（相对大小分别为 10.6%、16.6%和 18.1%），且剖宫产率较高（分别为 27.2%、30.9%和 33.0%）。当 Bishop 评分<6（n=2270/3042）时，剖宫产率较高（如果 Bishop 评分≥6，则为 24.1% vs 10.7%，P<0.01），特别是第 1 组（29.1% vs 12.5%，P=0.02）和第 2 组（33.3% vs 19.3%，P=0.01）。在对总剖宫产率贡献最大的第 1、2 和 3 组中，相当一部分剖宫产是由于产程中出现困难仅在宫颈扩张 6cm 之前进行（分别为 40.0%、16.7%和 17.6%）。
足月单胎头位且宫颈条件不佳的初产妇是审核引产实践的目标人群。可以在该人群中实施具体措施，权衡引产的利弊，并改善引产的管理。
