Urogynecology, Department of Obstetrics and Gynecology, Providence Saint John's Health Center, 2001 Santa Monica Blvd, Suite 680W, Santa Monica, CA, 90404, USA.
Division of Urogynecology, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Hartford, CT, USA.
Int Urogynecol J. 2024 Feb;35(2):311-317. doi: 10.1007/s00192-023-05637-8. Epub 2023 Aug 30.
In 2018, the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) concluded that routine induction of labor (IOL) at 39 weeks gestation decreases cesarean delivery risk, with slightly lighter birthweight infants. We debated whether routine IOL would improve, worsen, or not change POP risk compared with expectant management (EM).
We constructed a decision analysis model with a lifetime horizon where nulliparous women reaching 39 weeks underwent IOL or EM. Subsequent vaginal versus cesarean delivery varied based on prior deliveries for up to four births. Subsequent delivery prior to 39 weeks and distribution of gestational age, birthweight, and delivery mode between 24 and 39 weeks was modeled from national data. We modeled increased POP risk with increasing vaginal parity, forceps delivery, and weight of largest infant delivered vaginally, accounting for differential infant weights in each strategy.
IOL and EM have similar population-wide POP risk (15.9% and 15.7% respectively). Among women with only spontaneous vaginal deliveries that reached 39 weeks or beyond, the prevalence of POP was 20% after one delivery and 29% after four deliveries, with no difference between groups. The cesarean rate was lower with IOL (27.8% versus 29.8%). Sensitivity analysis revealed no meaningful thresholds among the variables, supporting model robustness.
While routine induction of labor at 39 weeks results in a meaningfully higher vaginal delivery rate, there was no increase in POP, possibly due to the protective effect of lower birthweight.
2018 年，ARRIVE 试验（诱导分娩与期待管理的随机试验）得出结论，在 39 孕周常规引产（IOL）可降低剖宫产率，且新生儿体重略轻。我们争论的是，与期待管理（EM）相比，常规 IOL 是否会改善、恶化或不改变 POP 风险。
我们构建了一个具有终生时间范围的决策分析模型，其中达到 39 孕周的初产妇接受 IOL 或 EM。随后的阴道分娩与剖宫产分娩根据之前的分娩情况而有所不同，最多可达 4 次分娩。在 39 孕周之前的后续分娩以及 24 至 39 孕周之间的妊娠周数、出生体重和分娩方式的分布，是基于全国数据进行建模的。我们通过增加阴道分娩次数、产钳分娩和经阴道分娩的最大婴儿体重来建模 POP 风险增加，同时考虑了每种策略中婴儿体重的差异。
IOL 和 EM 在人群中的 POP 风险相似（分别为 15.9%和 15.7%）。在仅进行自发性阴道分娩且达到 39 孕周或以上的女性中，一次分娩后 POP 的患病率为 20%，四次分娩后为 29%，两组之间无差异。IOL 的剖宫产率较低（27.8%对 29.8%）。敏感性分析表明，在变量之间没有有意义的阈值，支持模型的稳健性。
虽然在 39 孕周常规引产会导致阴道分娩率显著提高，但 POP 并无增加，这可能是由于较低的出生体重带来了保护作用。
