Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Am J Perinatol. 2022 Nov;39(15):1622-1632. doi: 10.1055/a-1877-8996. Epub 2022 Jun 16.
This study aimed to assess whether concordance with our proposed labor induction algorithm is associated with an increased rate of vaginal delivery within 24 hours.
We conducted a retrospective review of 287 induction of labors (IOLs) at a single urban, tertiary, academic medical center which took place before we created an evidence-based IOL algorithm. We then compared the IOL course to the algorithm to assess for concordance and outcomes. Patients age 18 years or over with a singleton, cephalic pregnancy of 36 to 42 weeks' gestation were included. Patients were excluded with a Bishop's score >6, contraindication to misoprostol or cervical Foley catheter, major fetal anomalies, or intrauterine fetal death. Patients with 100% concordance were compared with <100% concordant patients, and patients with ≥80% concordance were compared with <80% concordant patients. Adjusted hazard ratios (AHRs) were calculated for rate of vaginal delivery within 24 hours, our primary outcome. Competing risk's analysis was conducted for concordant versus nonconcordant groups, using vaginal delivery as the outcome of interest, with cesarean delivery (CD) as a competing event.
Patients with 100% concordance were more likely to have a vaginal delivery within 24 hours, = 66 of 77 or 85.7% versus = 120 of 210 or 57.1% ( < 0.0001), with an AHR of 2.72 (1.98, 3.75, < 0.0001) after adjusting for delivery indication and scheduled status. Patients with 100% concordance also had shorter time from first intervention to delivery (11.9 vs. 19.4 hours). Patients with ≥80% concordance had a lower rate of CD (11/96, 11.5%) compared with those with <80% concordance (43/191 = 22.5%; = 0.0238). There were no differences in neonatal outcomes assessed.
Our IOL algorithm may offer an opportunity to standardize care, improve the rate of vaginal delivery within 24 hours, shorten time to delivery, and reduce the CD rate for patients undergoing IOL.
· Studies on IOL have focused on individual steps. A labor induction algorithm allows for standardization.. · Algorithm concordance is associated with decreased time to delivery.. · Algorithm concordance is associated with decreased CD rate..
本研究旨在评估与我们提出的引产算法是否一致是否与 24 小时内阴道分娩率的增加有关。
我们对单中心城市三级学术医疗中心的 287 例引产（IOL）进行了回顾性研究，这些研究是在我们创建基于证据的 IOL 算法之前进行的。然后，我们将 IOL 过程与算法进行比较，以评估一致性和结果。纳入年龄在 18 岁及以上、单胎、头位、妊娠 36 至 42 周的孕妇。排除 Bishop 评分>6、米索前列醇或宫颈 Foley 导管禁忌、严重胎儿畸形或宫内胎儿死亡的患者。比较 100%符合率的患者与<100%符合率的患者，比较≥80%符合率的患者与<80%符合率的患者。计算了 24 小时内阴道分娩率的调整后危害比（AHR），这是我们的主要结果。使用阴道分娩作为感兴趣的结局，剖宫产（CD）作为竞争事件，对一致性与非一致性组进行了竞争风险分析。
100%符合率的患者更有可能在 24 小时内阴道分娩，=77/77 或 85.7%与=210/210 或 57.1%（<0.0001），调整分娩指征和计划状态后 AHR 为 2.72（1.98, 3.75，<0.0001）。100%符合率的患者从第一次干预到分娩的时间也更短（11.9 小时与 19.4 小时）。≥80%符合率的患者 CD 发生率较低（11/96，11.5%）与<80%符合率的患者（43/191，22.5%；=0.0238）。评估新生儿结局无差异。
我们的 IOL 算法可能为标准化护理提供机会，提高 24 小时内阴道分娩率，缩短分娩时间，降低 IOL 患者的 CD 率。
·关于 IOL 的研究主要集中在单个步骤上。分娩诱导算法允许标准化。·算法一致性与分娩时间缩短有关。·算法一致性与 CD 率降低有关。
