The University of Sydney Northern Clinical School, Women and Babies Research, Sydney, NSW, Australia. Email:
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. Email:
Aust Health Rev. 2021 Aug;45(4):418-424. doi: 10.1071/AH20237.
Objective This study examined hospitalisations and associated in-patient costs for babies during the first year of life following spontaneous labour, compared with labour induction or prelabour Caesarean section, at each gestational age. Methods Birth data for singleton liveborn babies from 33 weeks gestation in New South Wales from 2005 to 2014 were linked to hospital and death data. Generalised linear models were used to examine the association between the type of labour and the length of hospitalisations and hospital costs. Results From 2005 to 2014, 598640 women gave birth to 1187451 liveborn singleton babies. The mean total length of hospitalisations and costs of hospitalisations for babies in the first year of life decreased significantly as week of gestational age increased to 39 weeks, then plateaued. Overall, the total length of hospitalisations and hospital costs were significantly (P<0.001) lower for babies born after spontaneous labour (5.6 days and A$8405 respectively) than for babies born following labour induction (6.1 days and A$9452 respectively) or prelabour Caesarean section (8.2 days and A$12320 respectively). Conclusions Babies born following spontaneous labour spend less time in hospital and have lower hospital costs than those born following labour induction or prelabour Caesarean section. Hospitalisations and costs decrease with each week of gestational age until 39 weeks. What is known about the topic? It is known that induction of labour and prelabour Caesarean sections are increasing, and this increase has changed the distribution of gestational age towards birth at earlier ages. It is also known that babies born before 39 weeks of gestation are at increased risk of mortality and morbidity. What does this paper add? This study shows that babies born following spontaneous labour spend the least amount of time in hospital and subsequently have the lowest hospital costs at each week of gestation compared with babies born following labour induction or prelabour Caesarean section. This study also shows a small but significant economic advantage of labour induction compared with prelabour Caesarean delivery. This study quantifies the mean time babies spend in hospital in their first year of life, by week of gestational age and mode of birth. What are the implications for practitioners? The findings from this study can assist clinicians in judicious decision making when balancing the risks and benefits of early planned births. Clinicians can use the results of this study to inform women who are intending to have a planned birth of risks they may not have anticipated, such as the increased risk of rehospitalisation. The finding that hospitalisations and costs continue to decline until 39 weeks gestation can be used to reinforce the importance of continuing the pregnancy beyond 37 weeks if safe to do so, even though 37 weeks is considered term.
目的 本研究旨在比较自发性分娩、分娩诱导或产前剖宫产在每个胎龄时婴儿出生后第一年的住院情况和相关住院费用。
方法 2005 年至 2014 年期间，新南威尔士州 33 周以上单胎活产婴儿的分娩数据与医院和死亡数据相关联。使用广义线性模型来检查分娩方式与住院时间和住院费用之间的关系。
结果 2005 年至 2014 年期间，598640 名妇女分娩了 1187451 名单胎活产婴儿。随着胎龄增加到 39 周，婴儿出生后第一年的总住院时间和住院费用明显下降，然后趋于平稳。总体而言，与分娩诱导（6.1 天，A$9452）或产前剖宫产（8.2 天，A$12320）相比，自发性分娩婴儿的总住院时间（5.6 天，A$8405）和住院费用明显较低（均 P<0.001）。
结论 与分娩诱导或产前剖宫产相比，自发性分娩婴儿的住院时间更短，住院费用更低。随着胎龄的增加，住院时间和费用每周减少一次，直到 39 周。
已知主题是什么？ 已知诱导分娩和产前剖宫产的比例在增加，这种增加改变了分娩时的胎龄分布，使分娩提前。也已知，胎龄不足 39 周的婴儿死亡和发病风险增加。
这篇论文增加了什么？ 本研究表明，与分娩诱导或产前剖宫产相比，自发性分娩婴儿在每个胎龄时的住院时间最短，随后的住院费用最低。本研究还表明，与产前剖宫产相比，诱导分娩具有较小但显著的经济优势。本研究量化了婴儿在出生后第一年按胎龄和分娩方式在医院度过的平均时间。
对从业者意味着什么？ 本研究的结果可以帮助临床医生在权衡早期计划分娩的风险和益处时做出明智的决策。临床医生可以使用本研究的结果告知打算进行计划分娩的女性，她们可能没有预料到的风险，例如再次住院的风险增加。在 39 周时，住院时间和费用持续下降的发现可以用来强化在安全的情况下，即使 37 周被认为是足月，也应将妊娠延长至 37 周以上的重要性。
