Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2023 Dec;40(16):1725-1731. doi: 10.1055/a-2099-4395. Epub 2023 May 24.
The aim of the study was to identify the characteristics associated with spontaneous labor onset in pregnant patients undergoing expectant management at greater than 39 weeks' gestation and delineate perinatal outcomes associated with spontaneous labor compared with labor induction.
This was a retrospective cohort study of singleton pregnancies at ≥39 weeks' gestation delivered at a single center in 2013. The exclusion criteria were elective induction, cesarean delivery or presence of a medical indication for delivery at 39 weeks, more than one prior cesarean delivery, and fetal anomaly or demise. We evaluated prenatally available maternal characteristics as potential predictors of the primary outcome-spontaneous labor onset. Multivariable logistic regression was used to generate two parsimonious models: one with and one without third trimester cervical dilation. We also performed sensitivity analysis by parity and timing of cervical examination, and compared the mode of delivery and other secondary outcomes between patients who went into spontaneous labor and those who did not.
Of 707 eligible patients, 536 (75.8%) attained spontaneous labor and 171 (24.2%) did not. In the first model, maternal body mass index (BMI), parity, and substance use were identified as the most predictive factors. Overall, the model did not predict spontaneous labor (area under the curve [AUC]: 0.65; 95% confidence interval [CI]: 0.61-0.70) with high accuracy. The addition of third trimester cervical dilation in the second model did not significantly improve labor prediction (AUC: 0.66; 95% CI: 0.61-0.70; = 0.76). These results did not differ by timing of cervical examination or parity. Patients admitted in spontaneous labor had lower odds of cesarean delivery (odds ratio [OR]: 0.33; 95% CI: 0.21-0.53) and neonatal intensive care unit (NICU) admission (OR: 0.38; 95% CI: 0.15-0.94). Other perinatal outcomes were similar between the groups.
Maternal characteristics did not predict spontaneous labor onset at ≥39 weeks' gestation with high accuracy. Patients should be counseled on the challenges of labor prediction regardless of parity and cervical examination, outcomes if spontaneous labor does not occur, and benefits of labor induction.
· Majority of patients will attain spontaneous labor at ≥39 weeks.. · Maternal characteristics do not predict labor at ≥39 weeks.. · Spontaneous labor has associated lower perinatal risks.. · A shared decision model should be utilized in counseling patients who may choose expectant management..
本研究旨在确定大于 39 孕周行期待管理的孕妇自然临产的相关特征，并描述与引产相比自然临产的围产期结局。
这是一项 2013 年在单中心进行的、纳入≥39 孕周单胎妊娠的回顾性队列研究。排除标准为选择性引产、剖宫产分娩或 39 周时存在分娩医学指征、既往剖宫产>1 次、胎儿异常或死亡。我们评估了产前可获得的母体特征，作为自然临产这一主要结局的潜在预测因素。多变量逻辑回归生成了两个简洁的模型：一个包含和一个不包含孕晚期宫颈扩张的模型。我们还通过产次和宫颈检查时间进行敏感性分析，并比较了进入自然临产和未进入自然临产患者的分娩方式和其他次要结局。
在 707 例合格患者中，536 例（75.8%）进入自然临产，171 例（24.2%）未进入自然临产。在第一个模型中，母体体重指数（BMI）、产次和物质使用被确定为最具预测性的因素。总体而言，该模型对自然临产的预测准确性较高（曲线下面积[AUC]：0.65；95%置信区间[CI]：0.61-0.70）。第二个模型中增加孕晚期宫颈扩张并不能显著改善分娩预测（AUC：0.66；95%CI：0.61-0.70；=0.76）。这些结果不因宫颈检查时间或产次而异。自然临产入院的患者剖宫产（比值比[OR]：0.33；95%CI：0.21-0.53）和新生儿重症监护病房（NICU）入住（OR：0.38；95%CI：0.15-0.94）的可能性较低。两组的其他围产期结局相似。
母体特征并不能以较高的准确性预测≥39 孕周时的自然临产。无论产次和宫颈检查如何，都应告知患者分娩预测的挑战、如果自然临产未发生的结局以及引产的益处。
·大多数患者在≥39 孕周时会出现自发性临产。
·母体特征不能预测≥39 孕周时的分娩。
·自发性临产与较低的围产期风险相关。
·应利用共同决策模型为可能选择期待管理的患者提供咨询。
