Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
J Matern Fetal Neonatal Med. 2022 Oct;35(20):3964-3971. doi: 10.1080/14767058.2020.1844658. Epub 2020 Nov 12.
The objective of this study was to quantify the association between duration of labor induction in nulliparous women with hypertensive disorders of pregnancy and maternal and neonatal morbidity.
This was a secondary analysis of a multicenter cohort study of 228,438 deliveries in 19 U.S. hospitals. The analysis included nulliparous women ≥18 years old with singleton gestation diagnosed with hypertensive disorders of pregnancy and undergoing induction of labor for that indication. Duration of labor induction, defined as time from admission to delivery, was examined by 4 h intervals from <12 h to ≥24 h in relation to maternal and neonatal composite outcomes. Maternal composite outcome included operative vaginal delivery, chorioamnionitis, blood transfusion, intensive care unit admission, placental abruption, 3rd or 4th degree perineal laceration, endometritis, postpartum hemorrhage, or venous thromboembolism. Neonatal composite outcome included neonatal intensive care unit (NICU) admission, respiratory distress syndrome, 5-minute Apgar score ≤7, seizure, infection, intrapartum meconium aspiration, intracranial hemorrhage, shoulder dystocia, and neonatal death. The trends in proportions of outcomes that occurred at different intervals were examined by Cochran-Armitage trend test. Relative risks were calculated with <12 h as the reference category and potential confounders adjusted by log-binomial or Poisson regression. Possible correlations within centers were taken into account using generalized estimating equations.
A total of 3,990 women met inclusion criteria. The median labor duration was 19.8 h (interquartile range 12.9 h-27.9h), with 849 (21.3%) lasting <12 h and 1,426 (35.7%) >24 h. The frequency of composite maternal outcome was not associated with labor duration; however, the rates of chorioamnionitis ( < .001) and postpartum hemorrhage ( < .001) increased as labor duration increased. The frequency of composite neonatal outcome was greater with increasing labor duration ( < .001). After multivariable adjustment, duration of labor induction was associated with increased risks of maternal composite outcome after 24 h (aRR 1.39, 95% CI 1.20-1.62) and neonatal composite outcome after 24 h (aRR 1.32, 95% CI 1.11-1.56).
In nulliparous women with hypertensive disorders of pregnancy, duration of labor induction was associated with increased risks for maternal and neonatal morbidity after 24 h.
本研究旨在量化初产妇子痫前期孕妇引产时间与母婴发病率和新生儿发病率之间的关系。
这是对 19 家美国医院 228438 例分娩的多中心队列研究的二次分析。该分析纳入了年龄≥18 岁、单胎妊娠、诊断为子痫前期并因该指征行引产的初产妇。引产持续时间定义为从入院到分娩的时间，根据<12 小时至≥24 小时的 4 小时间隔，与母婴复合结局相关。母体复合结局包括阴道手术分娩、绒毛膜羊膜炎、输血、入住重症监护病房、胎盘早剥、3 度或 4 度会阴裂伤、子宫内膜炎、产后出血或静脉血栓栓塞。新生儿复合结局包括新生儿重症监护病房（NICU）入住、呼吸窘迫综合征、5 分钟 Apgar 评分≤7、癫痫发作、感染、产时胎粪吸入、颅内出血、肩难产和新生儿死亡。采用 Cochran-Armitage 趋势检验检查不同时间间隔发生结局的比例趋势。以<12 小时为参考类别，通过对数二项式或泊松回归调整潜在混杂因素，计算相对风险。采用广义估计方程考虑中心内的可能相关性。
共有 3990 名妇女符合纳入标准。中位产程为 19.8 小时（四分位距 12.9-27.9 小时），849 名（21.3%）<12 小时，1426 名（35.7%）>24 小时。母体复合结局的发生率与产程无相关性;然而，绒毛膜羊膜炎（<.001）和产后出血（<.001）的发生率随着产程的延长而增加。随着产程的延长，新生儿复合结局的发生率增加（<.001）。多变量调整后，24 小时后引产持续时间与母体复合结局风险增加相关（ARR 1.39，95%CI 1.20-1.62），24 小时后新生儿复合结局风险增加（ARR 1.32，95%CI 1.11-1.56）。
在患有子痫前期的初产妇中，引产时间与 24 小时后母婴发病率增加有关。
