Department of Midwifery Science, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, AVAG, Amsterdam, the Netherlands.
Department of Obstetrics and Gynaecology, Haga Ziekenhuis, The Hague, The Netherlands.
Birth. 2022 Sep;49(3):569-581. doi: 10.1111/birt.12628. Epub 2022 Feb 28.
Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality.
We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses.
The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included.
Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.
产妇特征，如产次和年龄，越来越被认为是健康妇女常规引产的指征，以预防胎儿和新生儿死亡。为了充分平衡引产的风险和收益，我们研究了其他相关产妇特征和孕龄与胎儿和新生儿死亡的关系。
我们在荷兰进行了一项全国性的回顾性队列研究，纳入了 2000 年至 2018 年间在助产士主导的护理下，孕 37 周后分娩的所有单胎妊娠。我们研究了产妇种族、年龄、产次和社会经济地位与胎儿和新生儿死亡的关系，按孕龄分层。使用描述性统计、单变量和多变量逻辑回归分析来检查单一特征的相关性。使用交叉分类分析和多变量逻辑回归分析中的交互项来检查多个特征的相关性。
结果表明，种族、年龄、产次、社会经济地位和孕龄并不是胎儿和新生儿死亡的单一决定因素。胎儿和新生儿死亡的概率因考虑的决定因素和纳入的决定因素数量而异。
基于单一决定因素决定引产以预防胎儿和新生儿死亡的决策可能导致过度使用或低估 IOL。基于价值的医疗保健策略，解决社会不平等问题，以及投资更好的筛查和诊断方法，采用个体化和多决定因素方法，可能更有效地预防胎儿和新生儿死亡。
