von Dadelszen Peter, Tohill Susan, Wade Julie, Hutcheon Jennifer A, Scott Janet, Green Marcus, Thornton James G, Magee Laura A
Institute of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
Front Glob Womens Health. 2022 Nov 21;3:936770. doi: 10.3389/fgwh.2022.936770. eCollection 2022.
To determine the extent to which a sample of NHS labor induction leaflets reflects evidence on labor induction.
Audit of labor induction patient information leaflets-local from WILL trial (When to Induce Labor to Limit risk in pregnancy hypertension) internal pilot sites or national-level available online.
Descriptive analysis [ = 21 leaflets, 19 (one shared) in 20 WILL internal pilot sites and 2 NHS online] according to NHS "Protocol on the Production of Patient Information" criteria: general information (including indications), why and how induction is offered (including success and alternatives), and potential benefits and harms.
All leaflets described an induction indication. Most leaflets ( = 18) mentioned induction location and 16 the potential for delays due to delivery suite workloads and competing clinical priorities. While 19 leaflets discussed membrane sweeping (17 as an induction alternative), only 4 leaflets mentioned balloon catheter as another mechanical method. Induction success (onset of active labor) was presented by a minority of leaflets ( = 7, 33%), as "frequent" or in the "majority", with "rare" or "occasional" failures. Benefits, harms and outcomes following induction were not compared with expectant care, but rather with spontaneous labor, such as for pain ( = 14, with nine stating more pain with induction). Potential benefits of induction were seldom described [ = 7; including avoiding stillbirth ( = 4)], but deemed to be likely. No leaflet stated vaginal birth was more likely following induction, but most stated Cesarean was not increased ( = 12); one leaflet stated that Cesarean risks were increased following induction. Women's satisfaction was rarely presented ( = 2).
Information provided to pregnant women regarding labor induction could be improved to better reflect women's choice between induction and expectant care, and the evidence upon which treatment recommendations are based. A multiple stakeholder-involved and evidence-informed process to update guidance is required.
确定英国国家医疗服务体系（NHS）引产宣传册样本在多大程度上反映了引产相关证据。
对引产患者信息宣传册进行审核——来自WILL试验（何时引产以降低妊娠高血压风险）内部试点的本地宣传册或可在线获取的国家级宣传册。
根据NHS“患者信息制作协议”标准进行描述性分析[共21份宣传册，其中20个WILL内部试点中有19份（有1份重复），以及2份NHS在线宣传册]：一般信息（包括适应症）、提供引产的原因和方式（包括成功率及替代方案）以及潜在的益处和危害。
所有宣传册都描述了引产适应症。大多数宣传册（共18份）提到了引产地点，16份提到了由于分娩室工作量和其他临床优先事项可能导致的延误。虽然19份宣传册讨论了人工破膜（17份将其作为引产替代方案），但只有4份宣传册提到球囊导管作为另一种机械引产方法。少数宣传册（共7份，占33%）将引产成功率（活跃产程开始）描述为“常见”或“大多数情况”，失败情况为“罕见”或“偶尔发生”。引产的益处、危害和结果未与期待治疗进行比较，而是与自然分娩进行了比较，例如疼痛方面（共14份，其中9份表示引产时疼痛更剧烈）。很少描述引产的潜在益处[共7份；包括避免死产（共4份）]，但认为可能有这些益处。没有宣传册表明引产后宫内分娩更有可能，但大多数宣传册表明剖宫产率没有增加（共12份）；有1份宣传册表明引产后剖宫产风险增加。很少提及女性的满意度（共2份）。
向孕妇提供的关于引产的信息可以得到改进，以更好地反映女性在引产和期待治疗之间的选择，以及治疗建议所依据的证据。需要一个多方利益相关者参与且基于证据的过程来更新指南。
