Departments of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, McGovern Medical School-Children's Memorial Hermann Hospital, Houston, Texas.
George Washington University Biostatistics Center, Washington, District of Columbia.
Am J Perinatol. 2022 Apr;39(5):519-525. doi: 10.1055/s-0040-1716711. Epub 2020 Sep 11.
Our objective was to compare outcomes among low-risk parous women who underwent elective labor induction at 39 weeks versus expectant management.
This is a secondary analysis of an observational cohort of 115,502 mother-infant dyads who delivered at 25 hospitals between 2008 and 2011. The inclusion criteria for this analysis were low-risk parous women with nonanomalous singletons with at least one prior vaginal delivery after 20 weeks, who delivered at ≥39 weeks. Women who electively induced between 39 and 39 weeks were compared with women who expectantly managed ≥39 weeks. The primary outcome for this analysis was cesarean delivery. Secondary outcomes were composites of maternal adverse outcome and neonatal adverse outcome. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR).
Of 20,822 women who met inclusion criteria, 2,648 (12.7%) were electively induced at 39 weeks. Cesarean delivery was lower among women who underwent elective induction at 39 weeks than those who did not (2.4 vs. 4.6%, adjusted odds ratio [aOR]: 0.70, 95% confidence interval [CI]: 0.53-0.92). The frequency of the composite maternal adverse outcome was significantly lower for the elective induction cohort as well (1.6 vs. 3.1%, aOR: 0.66, 95% CI: 0.47-0.93). The composite neonatal adverse outcome was not significantly different between the two groups (0.3 vs. 0.6%; aOR: 0.60, 95% CI: 0.29-1.23).
In low-risk parous women, elective induction of labor at 39 weeks was associated with decreased odds of cesarean delivery and maternal morbidity, without an increase in neonatal adverse outcomes.
· 39-week elective induction is associated with decreased cesarean delivery in low-risk parous women.. · Compared with expectant management, maternal adverse outcomes were lower with elective induction.. · Neonatal adverse outcomes are unchanged between elective and expectant management groups..
本研究旨在比较低危经产妇在 39 孕周行选择性引产与期待管理的结局。
这是对 2008 年至 2011 年间在 25 家医院分娩的 115502 例母婴对进行的一项观察性队列的二次分析。本分析的纳入标准为：低危经产妇，单胎妊娠，至少有一次 20 周后经阴道分娩，孕龄≥39 周。39 周至 39 周行选择性引产的产妇与≥39 周行期待管理的产妇进行比较。本分析的主要结局为剖宫产。次要结局为产妇不良结局和新生儿不良结局的复合结局。采用多变量逻辑回归估计校正优势比（aOR）。
在符合纳入标准的 20822 名产妇中，有 2648 名（12.7%）在 39 孕周行选择性引产。与未行选择性引产的产妇相比，39 周行选择性引产的产妇剖宫产率较低（2.4% vs. 4.6%，校正优势比[aOR]：0.70，95%置信区间[CI]：0.53-0.92）。选择性引产组的产妇不良结局复合发生率也显著降低（1.6% vs. 3.1%，aOR：0.66，95% CI：0.47-0.93）。两组新生儿不良结局复合发生率无显著差异（0.3% vs. 0.6%；aOR：0.60，95% CI：0.29-1.23）。
在低危经产妇中，39 周行选择性引产与剖宫产率和产妇发病率降低相关，而新生儿不良结局无增加。
·39 周选择性引产与低危经产妇的剖宫产率降低相关。·与期待管理相比，选择性引产的产妇不良结局发生率更低。·选择性引产组与期待管理组新生儿不良结局发生率无差异。
