Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.
Am J Perinatol. 2024 May;41(S 01):e1061-e1068. doi: 10.1055/a-1990-8411. Epub 2022 Nov 30.
Prior studies have demonstrated the potential benefit of nonmedically indicated induction of labor for nulliparous women at 39 weeks of gestation, yet few have studied the impact of this management strategy in different maternal age groups on obstetric outcomes. We sought to assess whether obstetric outcomes among women undergoing nonmedically indicated induction of labor at 39 weeks of gestation as compared with expectant management vary based on maternal age.
This was a retrospective cohort study of singleton, nonanomalous, deliveries between 2007 and 2012 in California. We defined nonmedically indicated induction of labor as induction of labor without a specific medical indication, and women with planned cesarean sections were excluded. We compared induction of labor with expectant management beyond the gestational age of induction and examined this comparison in different maternal age groups. Numerous maternal and neonatal outcomes were examined. Chi-squared and multivariable logistic regression analyses were used for statistical comparisons and a -value of less than 0.05 was used to indicate statistical significance.
A total of 630,485 women-infant dyads met our inclusion criteria and were included in this study. At 39 weeks' gestation, 6% of women underwent nonmedically indicated induction of labor and 94% underwent expectant management. Women 20 to 34 and ≥35 years old had lower odds of cesarean delivery if they underwent induction of labor. Women of all ages undergoing nonmedically indicated induction of labor had higher odds of operative vaginal delivery. Neonatal outcomes were better with nonmedically indicated induction of labor, including lower odds of neonatal intensive care unit admission and neonatal respiratory distress.
Our study demonstrated that obstetric outcomes vary among women undergoing nonmedically indicated induction of labor compared with expectant management when stratified by maternal age. These findings illustrate the importance of understanding age-related differences in outcomes associated with nonmedically indicated induction of labor.
· Outcomes are different by age with nonmedically indicated induction of labor (IOL).. · The odds of cesarean delivery with IOL decreases with increasing maternal age compared with expectant management.. · Neonatal outcomes were improved with IOL compared with expectant management..
先前的研究表明，对 39 孕周的初产妇进行非医学指征引产具有潜在益处，但很少有研究探讨这种管理策略在不同产妇年龄组中对产科结局的影响。我们旨在评估与期待管理相比，39 孕周时非医学指征引产的产妇产科结局是否因产妇年龄而异。
这是一项回顾性队列研究，纳入了 2007 年至 2012 年加利福尼亚州的单胎、非畸形分娩。我们将非医学指征引产定义为没有具体医学指征的引产，且排除计划行剖宫产术的孕妇。我们比较了引产与超过引产孕周的期待管理，并在不同产妇年龄组中比较了这两种方法。研究考察了许多产妇和新生儿结局。采用卡方检验和多变量逻辑回归分析进行统计学比较，p 值＜0.05 表示差异具有统计学意义。
共有 630485 对母婴符合纳入标准并纳入本研究。在 39 孕周时，6%的产妇行非医学指征引产，94%的产妇行期待管理。如果行引产，20 至 34 岁和≥35 岁的产妇行剖宫产术的几率较低。所有年龄组行非医学指征引产的产妇行阴道助产分娩的几率较高。行非医学指征引产的新生儿结局较好，包括新生儿重症监护病房入住率和新生儿呼吸窘迫发生率较低。
我们的研究表明，按产妇年龄分层时，与期待管理相比，行非医学指征引产的产妇产科结局不同。这些发现表明，理解与非医学指征引产相关的结局的年龄相关差异非常重要。
· 非医学指征引产的结局因年龄而异。· 与期待管理相比，行引产时，产妇年龄越大，行剖宫产术的几率越低。· 与期待管理相比，行引产可改善新生儿结局。
