Butler Sarah E, Wallace Euan M, Bisits Andrew, Selvaratnam Roshan J, Davey Mary-Ann
Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
Department of Health, Melbourne, Victoria, Australia.
Birth. 2024 Sep;51(3):521-529. doi: 10.1111/birt.12806. Epub 2024 Jan 3.
To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial.
Population-based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi-square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance.
Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower-risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13-1.32)), 39 (aOR 1.31(1.23-1.40)), 40 (aOR 1.42(1.35-1.50)), and 41 weeks of gestation (aOR 1.43(1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations.
For lower-risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only.
在非随机对照试验范围内，评估与期待管理相比，足月单胎初产无并发症情况下引产与剖宫产及围产期死亡率是否相关。
基于人群的回顾性队列研究，研究对象为2010年至2018年澳大利亚维多利亚州的所有分娩（n = 640,191）。初步分析比较了孕37周时引产与该孕周及之后的期待管理对无并发症妊娠的情况。对孕38、39、40和41周时的引产及期待管理也进行了类似比较。主要分析重复了这些比较，将人群限制为无并发症妊娠的初产妇，并排除有引产医学指征的产妇。我们使用卡方检验比较组间围产期死亡率，对所有其他比较使用多变量逻辑回归。报告调整后的比值比和99%置信区间。p < 0.01表示具有统计学意义。
在维多利亚州孕≥37周的初产无并发症妊娠中，引产率从2010年的24.6%上升至2018年的30.0%（p < 0.001）。与初步分析相反，主要分析显示，低风险初产妇在孕38周（调整后比值比1.23(1.13 - 1.32)）、39周（调整后比值比1.31(1.23 - 1.40)）、40周（调整后比值比1.42(1.35 - 1.50)）和41周（调整后比值比1.43(1.35 - 1.51)）进行引产与剖宫产几率增加相关。两组围产期死亡率均较低，且在大多数孕周引产组的围产期死亡率略低但无统计学意义。
对于低风险初产妇，从孕38周起引产与剖宫产几率增加相关，仅在孕41周时围产期死亡率几率降低。
