Jeer Bavita, Haberfeld Emily, Khalil Asma, Thangaratinam Shakila, Allotey John
College of Medical and Dental Sciences, University of Birmingham, Birmingham, Northern Ireland, United Kingdom.
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular and Clinical Sciences Research Institute, St George's University of London, London, Northern Ireland, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2023 Sep;288:175-182. doi: 10.1016/j.ejogrb.2023.07.021. Epub 2023 Aug 4.
The risk of adverse perinatal and maternal outcomes increases with gestational age, and although induction of labour may reduce these risks, the optimal timing of induction remains unknown. We carried out a systematic review and meta-analysis, to determine the gestational age at which induction should be offered. We searched Cochrane Central Register of Controlled Trials, Medline, and Embase databases from inception to July 2022, to identify randomised trials comparing induction of labour at or beyond 37' weeks gestation with expectant management or delayed induction, and according to the gestational age at planned induction. We undertook random effects meta-analysis and pooled estimates as odds ratios with 95% confidence intervals. We assessed risk of bias of studies using the Cochrane Risk of Bias tool 2.0. We included 44 trials (23,960 women and 22,191 offspring) from 1,839 citations in our meta-analysis. The odds of perinatal death (odds ratio 0.42, 95% confidence interval 0.22 to 0.81; 26 studies, 20,154 offspring), stillbirth (0.40, 0.16 to 0.98; 25 studies, 19,412 offspring), admission to neonatal intensive care unit (0.86, 0.78 to 0.96; 23 studies, 18,846 offspring), and caesarean section (0.90, 0.83 to 0.98; 40 studies, 23,616 women) were reduced in the induction of labour group compared to expectant management or delayed induction. The odds of admission to neonatal intensive care unit (0.82, 0.70 to 0.96; 6 studies, 9,316 offspring) were lower with induction of labour at 41 weeks compared to induction at or after 42 weeks' gestation, and the odds of caesarean section were reduced with labour induction at 39 weeks' compared to induction at or after 40 weeks' (0.83, 0.74 to 0.93; 8 studies, 7,677 women). There were no significant differences in pregnancy outcomes by method of induction of labour. Induction of labour compared to expectant management or delayed induction reduces the risk of adverse pregnancy outcomes, and the optimal timing may depend on the specific outcome of interest.
围产期和产妇不良结局的风险会随着孕周增加而上升，尽管引产可能会降低这些风险，但引产的最佳时机仍不明确。我们进行了一项系统评价和荟萃分析，以确定应该进行引产的孕周。我们检索了Cochrane对照试验中心注册库、Medline和Embase数据库，检索时间从建库至2022年7月，以识别比较妊娠37周及以后引产与期待管理或延迟引产的随机试验，并根据计划引产时的孕周进行分析。我们采用随机效应荟萃分析，并汇总估计值作为比值比及95%置信区间。我们使用Cochrane偏倚风险工具2.0评估研究的偏倚风险。我们的荟萃分析纳入了来自1839篇文献的44项试验（23960名女性和22191名后代）。与期待管理或延迟引产相比，引产组围产期死亡（比值比0.42，95%置信区间0.22至0.81；26项研究，20154名后代）、死产（0.40，0.16至0.98；25项研究，19412名后代）、入住新生儿重症监护病房（0.86，0.78至0.96；23项研究，18846名后代）和剖宫产（0.90，0.83至0.98；40项研究，23616名女性）的几率降低。与妊娠42周及以后引产相比，妊娠41周引产时入住新生儿重症监护病房的几率更低（0.82，0.70至0.96；6项研究，9316名后代），与妊娠40周及以后引产相比，妊娠39周引产时剖宫产几率降低（0.83，0.74至0.93；8项研究，7677名女性）。引产方法对妊娠结局无显著差异。与期待管理或延迟引产相比，引产可降低不良妊娠结局的风险，最佳时机可能取决于具体关注的结局。
