Langen Elizabeth S, Schiller Amy J, Moore Kathryn, Jiang Charley, Bourdeau Althea, Morgan Daniel M, Low Lisa Kane
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
The Obstetrics Initiative, Ann Arbor, Michigan.
Am J Perinatol. 2024 May;41(S 01):e1281-e1287. doi: 10.1055/s-0043-1761918. Epub 2023 Feb 16.
This article evaluates the impact of adopting a practice of elective induction of labor (eIOL) at 39 weeks among nulliparous, term, singleton, vertex (NTSV) pregnancies in a statewide collaborative.
We used data from a statewide maternity hospital collaborative quality initiative to analyze pregnancies that reached 39 weeks without a medical indication for delivery. We compared patients who underwent an eIOL versus those who experienced expectant management. The eIOL cohort was subsequently compared with a propensity score-matched cohort who were expectantly managed. The primary outcome was cesarean birth rate. Secondary outcomes included time to delivery and maternal and neonatal morbidities. Chi-square test, -test, logistic regression, and propensity score matching methods were used for analysis.
In 2020, 27,313 NTSV pregnancies were entered into the collaborative's data registry. A total of 1,558 women underwent eIOL and 12,577 were expectantly managed. Women in the eIOL cohort were more likely to be ≥35 years old (12.1 vs. 5.3%, < 0.001), identify as white non-Hispanic (73.9 vs. 66.8%, < 0.001), and be privately insured (63.0 vs. 61.3%, = 0.04). When compared with all expectantly managed women, eIOL was associated with a higher cesarean birth rate (30.1 vs. 23.6%, < 0.001). When compared with a propensity score-matched cohort, eIOL was not associated with a difference in cesarean birth rate (30.1 vs. 30.7%, = 0.697). Time from admission to delivery was longer for the eIOL cohort compared with the unmatched (24.7 ± 12.3 vs. 16.3 ± 11.3 hours, < 0.001) and matched (24.7 ± 12.3 vs. 20.1 ± 12.0 hours, < 0.001) cohorts. Expectantly managed women were less likely to have a postpartum hemorrhage (8.3 vs. 10.1%, = 0.02) or operative delivery (9.3 vs. 11.4%, = 0.029), whereas women who underwent an eIOL were less likely to have a hypertensive disorder of pregnancy (5.5 vs. 9.2%, < 0.001).
eIOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate.
· Elective IOL at 39 weeks may not be associated with a reduced NTSV cesarean delivery rate.. · The practice of elective induction of labor may not be equitably applied across birthing people.. · Further research is needed to identify best practices to support people undergoing labor induction..
本文评估了在一项全州范围内的合作项目中，对未生育、足月、单胎、头位（NTSV）妊娠的孕妇在39周时采用选择性引产（eIOL）做法的影响。
我们使用了一项全州范围内产妇医院合作质量倡议的数据，分析那些达到39周且无分娩医学指征的妊娠情况。我们比较了接受eIOL的患者与接受期待管理的患者。随后将eIOL队列与倾向评分匹配的接受期待管理的队列进行比较。主要结局是剖宫产率。次要结局包括分娩时间以及孕产妇和新生儿发病率。采用卡方检验、t检验、逻辑回归和倾向评分匹配方法进行分析。
2020年，共有27313例NTSV妊娠被纳入该合作项目的数据登记系统。共有1558名妇女接受了eIOL，12577名接受了期待管理。eIOL队列中的妇女更有可能年龄≥35岁（12.1%对5.3%，P<0.001），为非西班牙裔白人（73.9%对66.8%，P<0.001），且有私人保险（63.0%对61.3%，P = 0.04）。与所有接受期待管理的妇女相比，eIOL与更高的剖宫产率相关（30.1%对23.6%，P<0.001）。与倾向评分匹配的队列相比，eIOL与剖宫产率差异无统计学意义（30.1%对30.7%，P = 0.697）。与未匹配队列（24.7±12.3小时对16.3±11.3小时，P<0.001）和匹配队列（24.7±12.3小时对20.1±12.0小时，P<0.001）相比，eIOL队列从入院到分娩的时间更长。接受期待管理的妇女产后出血（8.3%对10.1%，P = 0.02）或手术分娩（9.3%对11.4%，P = 0.029）的可能性较小，而接受eIOL的妇女妊娠高血压疾病的可能性较小（5.5%对9.2%，P<0.001）。
39周时的eIOL可能与降低NTSV剖宫产率无关。
· 39周时的选择性引产可能与降低NTSV剖宫产率无关。· 选择性引产的做法可能未在所有分娩人群中公平应用。· 需要进一步研究以确定支持引产人群的最佳做法。
