Department of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
Department of Obstetrics and Gynecology, Finnmark Hospital Trust, Hammerfest, Norway.
Acta Obstet Gynecol Scand. 2020 Dec;99(12):1700-1709. doi: 10.1111/aogs.13948. Epub 2020 Jul 27.
Induction of labor has become an increasingly common obstetric procedure, but in nulliparous women or women with a previous cesarean section, it can pose a clinical challenge. Despite an overall expansion of medical indications for labor induction, there is little international consensus regarding the criteria for induction, or for the recommended methods among nulliparous women. In this light, we assessed variations in the practice of induction of labor among 21 birth units in a nationwide cohort of women with no prior vaginal birth.
We carried out a prospective observational pilot study of women with induced labor and no prior vaginal birth, across 21 Norwegian birth units. We registered induction indications, methods and outcomes from 1 September to 31 December 2018 using a web-based case record form. Women were grouped into "Nulliparous term cephalic", "Previous cesarean section" and "Other Robson" (Robson groups 6, 7, 8 or 10).
More than 98% of eligible women (n=1818) were included and a wide variety of methods was used for induction of labor. In nulliparous term cephalic pregnancies, cesarean section rates ranged from 11.1% to 40.6% between birth units, whereas in the previous cesarean section group, rates ranged from 22.7% to 67.5%. The indications "large fetus" and "other fetal" indications were associated with the highest cesarean rates. Failed inductions and failure to progress in labor contributed most to the cesarean rates. Uterine rupture occurred in two women (0.11%), both in the previous cesarean section group. In neonates, 1.6% had Apgar <7 at 5 minutes, and 0.4% had an umbilical artery pH <7.00.
Cesarean rates and applied methods for induction of labor varied widely in this nationwide cohort of women without a prior vaginal birth. Neonatal outcomes were similar to those of normal birth populations. Results could indicate the need to move towards more standardized induction protocols associated with optimal outcomes for mother and baby.
引产已成为一种越来越常见的产科手术，但在初产妇或有剖宫产史的妇女中，这可能是一个临床挑战。尽管引产的医学指征总体上有所扩大，但对于初产妇的引产指征或推荐方法，国际上几乎没有共识。有鉴于此，我们评估了在一个全国性的初产妇队列中，21 个分娩单位在引产实践方面的差异。
我们对 21 个挪威分娩单位的初产妇引产进行了一项前瞻性观察性试点研究。我们使用基于网络的病例记录表，在 2018 年 9 月 1 日至 12 月 31 日期间登记引产的指征、方法和结局。将孕妇分为“足月初产妇”、“既往剖宫产”和“其他罗伯逊组”（罗伯逊组 6、7、8 或 10）。
超过 98%的符合条件的妇女（n=1818）被纳入研究，并且广泛使用了各种方法进行引产。在足月初产妇中，各分娩单位的剖宫产率从 11.1%到 40.6%不等，而在既往剖宫产组中，剖宫产率从 22.7%到 67.5%不等。“巨大儿”和“其他胎儿”指征与最高的剖宫产率相关。引产失败和产程进展不良是导致剖宫产率升高的主要原因。两名妇女（0.11%）发生子宫破裂，均发生在既往剖宫产组。新生儿中，1.6%的新生儿在 5 分钟时 Apgar 评分<7，0.4%的新生儿脐动脉 pH 值<7.00。
在这个没有阴道分娩史的全国性妇女队列中，剖宫产率和引产方法差异很大。新生儿结局与正常分娩人群相似。结果可能表明需要转向与母婴最佳结局相关的更标准化的引产方案。
