与埃塞俄比亚阿姆哈拉地区转诊医院引产相关的因素和结果：一项多中心研究。
Factors and outcomes associated with the induction of labor in referral hospitals of Amhara regional state, Ethiopia: a multicenter study.
机构信息
Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, PO. Box 196, Gondar, Ethiopia.
Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
BMC Pregnancy Childbirth. 2021 Mar 20;21(1):225. doi: 10.1186/s12884-021-03709-5.
BACKGROUND
Induction of labor is an artificial initiation of uterine contractions after fetal viability with the aim of vaginal delivery prior to the onset of spontaneous labor. Prevalence of induction of labor is increasing worldwide with subsequent increase in failure rate. However, there is limited evidence on labor induction in Ethiopia. Therefore, this study was aimed at assessing the prevalence and associated factors of failed induction of labor among women undergoing induction of labor at referral hospitals of Amhara national regional state, Ethiopia, 2016.
METHOD
A multicenter cross-sectional study was conducted at referral hospitals found in Amhara national regional state from February 01 to September 30, 2016. Multistage sampling technique was employed to select a total of 484 women who underwent labor induction. Pre-tested structured questionnaires and checklists were used to collect the data. Data were entered into EPI info version 7 and analyzed using SPSS version 20 software. Stepwise Binary Logistic regression model was fitted to identify factors associated with failed induction of labor. The level of significance was determined based on the adjusted odds ratio with 95% confidence interval at the p-value of ≤0.05.
RESULT
The prevalence of failed induction of labor among women undergoing induction of labor was 31.4% (95% CI: 27.0, 36.0). Failed induction of labor was independently predicted by a Bishop score of ≤5 (AOR = 2.1; 95% CI: 1.3, 3.6), prolonged latent first stage of labor (AOR = 2.0; 95% CI: 1.2, 3.5), induction with oxytocin alone (AOR = 4.2; 95% CI: 2.2, 8.1), nulliparity (ARO = 1.9; 95% CI: 1.2, 2.9), post term pregnancy (AOR = 4.1; 95% CI: 1.8, 9.3) and hypertensive disorder of pregnancy (AOR = 2.4; 95% CI: 1.5, 5.1).
CONCLUSION
Failed induction of labor was high in the study area compared to the reports of previous studies done in Ethiopia. The majority of the determinants of failed induction of labor were connected with unjustifiable and inconsistent indication of induction of labor. Thus, preparing standardized practical guidelines and preventing unjustifiable case selection may help reduce the current high failure rates.
背景
分娩诱导是在胎儿存活后人为引发子宫收缩以在自发性分娩开始前实现阴道分娩的方法。分娩诱导的发生率在全球范围内呈上升趋势，随之而来的是失败率的上升。然而，在埃塞俄比亚，关于分娩诱导的证据有限。因此，本研究旨在评估在阿姆哈拉州立地区转诊医院进行分娩诱导的妇女中分娩诱导失败的发生率及其相关因素，研究时间为 2016 年 2 月 1 日至 9 月 30 日。
方法
这是一项在 2016 年 2 月 1 日至 9 月 30 日在阿姆哈拉州立地区的转诊医院进行的多中心横断面研究。采用多阶段抽样技术，共选择了 484 名接受分娩诱导的妇女。使用经过预测试的结构化问卷和检查表收集数据。数据录入 EPI info 版本 7，并使用 SPSS 版本 20 软件进行分析。采用逐步二项逻辑回归模型来确定与分娩诱导失败相关的因素。基于调整后的比值比和 95%置信区间，在 p 值≤0.05 时确定显著性水平。
结果
在接受分娩诱导的妇女中，分娩诱导失败的发生率为 31.4%（95%CI：27.0，36.0）。Bishop 评分≤5（AOR=2.1；95%CI：1.3，3.6）、潜伏期第一产程延长（AOR=2.0；95%CI：1.2，3.5）、单独使用催产素诱导（AOR=4.2；95%CI：2.2，8.1）、初产妇（ARO=1.9；95%CI：1.2，2.9）、过期妊娠（AOR=4.1；95%CI：1.8，9.3）和妊娠高血压疾病（AOR=2.4；95%CI：1.5，5.1）与分娩诱导失败独立相关。
结论
与之前在埃塞俄比亚进行的研究报告相比，研究地区的分娩诱导失败率较高。分娩诱导失败的大多数决定因素与分娩诱导的不合理和不一致的指征有关。因此，制定标准化的实用指南并防止不合理的病例选择可能有助于降低当前的高失败率。
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