Hu Y-F
Department of Obstetrics and Gynecology, Shanghai Pudong New Area Healthcare Hospital for Women and Children, Shanghai, China.
Eur Rev Med Pharmacol Sci. 2023 Mar;27(6):2552-2560. doi: 10.26355/eurrev_202303_31789.
This study aimed at exploring the association between labor induction at the 39th week and CD in the setting where the baseline cesarean delivery rate is high.
A retrospective cohort study was conducted during a 50-month period at a Shanghai-based secondary maternity hospital. A comparison was made of the maternal and neonatal outcomes, including the CD rate, between the women who underwent labor induction at the 39th week and those who were managed expectantly.
A total of 4,975 deliveries were included, which had been made by the low-risk nulliparous women beyond 39 weeks. The CD rate was 41.6% and 42.2% in the induction group (n = 202) and the expectant management group (n = 4,773), respectively (relative risk, 0.99; 95% CI, 0.83 to 1.17). Induction of labor at the 39th week increased the risk of postpartum hemorrhage ≥ 500 ml in 24 hours (adjusted relative risk, 2.32; 95% CI, 1.12 to 4.78) and intrapartum fever ≥ 37.5℃ (adjusted relative risk, 4.73; 95% CI, 2.13 to 10.49). Differences in other maternal and neonatal outcomes were of no clinical significance. When stratified by the indications for labor induction, CDs performed because of non-reassuring fetal heart rate were more prevalent among the women who were induced for the same reason than those who were not.
As compared with that in the expectant management, labor induction at the 39th week does not seem to have an impact on CD within the setting of a high CD rate.
本研究旨在探讨在剖宫产率较高的情况下，孕39周引产与剖宫产之间的关联。
在上海一家二级妇产医院进行了一项为期50个月的回顾性队列研究。对孕39周引产的妇女和期待治疗的妇女的母婴结局（包括剖宫产率）进行了比较。
共纳入4975例分娩，均为孕周超过39周的低风险初产妇。引产组（n = 202）和期待治疗组（n = 4773）的剖宫产率分别为41.6%和42.2%（相对风险，0.99；95%可信区间，0.83至1.17）。孕39周引产增加了24小时内产后出血≥500 ml的风险（校正相对风险，2.32；95%可信区间，1.12至4.78）和产时发热≥37.5℃的风险（校正相对风险，4.73；95%可信区间，2.13至10.49）。其他母婴结局的差异无临床意义。按引产指征分层时，因胎心异常而行剖宫产在因相同原因引产的妇女中比未引产的妇女更为普遍。
与期待治疗相比，在剖宫产率较高的情况下，孕39周引产似乎对剖宫产无影响。
