Turkmen Sahruh, Binfare Linnea
Department of Clinical Sciences, Obstetrics and Gynecology, Sundsvalls Research Unit, Umeå University, Umeå, SE 90185, Sweden.
Department of Obstetrics and Gynecology, Sundsvall County Hospital, Sundsvall, SE 85186, Sweden.
Eur J Obstet Gynecol Reprod Biol X. 2024 Sep 2;24:100339. doi: 10.1016/j.eurox.2024.100339. eCollection 2024 Dec.
It has been suggested that induction of labour before 42 weeks of pregnancy prevents foetal complications. To evaluate the maternal and foetal outcomes of induced and spontaneous labour beyond gestational week 41 + 0.
We conducted a register-based nationwide cohort study that included pregnant women who were delivered in Sweden in 2016-2021. Women were classified into two groups: induction of labour (IOL) or spontaneous onset of labour (SOL). Maternal and foetal outcomes after IOL in gestational week 41 were compared with SOL in gestational week 41 and 42.
Comparison between the IOL (n = 23,772) and SOL (n = 62,611) groups in gestational weeks 41 showed that various parameters were higher in the IOL group: caesarean deliveries (12.3 % and 4.6 %, < 0.001), vacuum extraction (8.7 % and 6.9 %, < 0.001), blood loss of > 1000 ml during labour (11 % vs 8.3 %, < 0.001). The risks were remained significant even after adjusting for potential confounders (caesarean delivery: aOR 2.36; 95 % CI, 2.23-2.50, vacuum delivery: aOR 1.09; 95 % CI, 1.03-1.16, = 0.002, and blood loss of >1000 ml: aOR 1.25; 95 % CI 1.18-1.31). The proportions of stillbirths (0.07 % and 0.18, < 0.001), and newborns with apgar scores < 4 at five minutes (0.4 % vs 0.3 %, < 0.001), were also higher in the IOL group. The risk of stillbirth after IOL in gestational week 41 was increased relative to SOL in the same week and remained high after adjusting for potential confounders (aOR 1.75; 95 % CI 1.07-2.80, = 0.025).The IOL group in gestational weeks 41 comprised a higher proportion of caesarean deliveries (12.3 % and 8.5 %, < 0.001), but a lower (8.7 % and 9.7 %, = 0.006) proportion of deliveries by vacuum extraction than the SOL group (n = 4548) in week 42.
Inducing labour at gestational week 41 in women with prolonged pregnancies may have adverse effects on foetal and maternal outcomes compared to those who experience spontaneous labour onset at the same gestational age. The risk of negative foetal outcomes after induction at week 41 appears similar to that in women who give birth after spontaneous labour at week 42.
有人提出在妊娠42周前引产可预防胎儿并发症。旨在评估妊娠41 + 0周后引产和自然分娩的母婴结局。
我们进行了一项基于登记的全国队列研究，纳入了2016 - 2021年在瑞典分娩的孕妇。女性被分为两组：引产（IOL）或自然发动分娩（SOL）。将妊娠41周引产的母婴结局与妊娠41周和42周自然分娩的结局进行比较。
妊娠41周时，引产组（n = 23,772）和自然分娩组（n = 62,611）的比较显示，引产组的各种参数更高：剖宫产率（12.3% 和4.6%，< 0.001）、真空吸引助产率（8.7% 和6.9%，< 0.001）、分娩期间失血> 1000 ml的比例（11% 对8.3%，< 0.001）。即使在调整潜在混杂因素后，这些风险仍然显著（剖宫产：校正后比值比[aOR] 2.36；95% 置信区间[CI]，2.23 - 2.50，真空助产：aOR 1.09；95% CI，1.03 - 1.16，P = 0.002，失血> 1000 ml：aOR 1.25；95% CI 1.18 - 1.31）。引产组的死产比例（0.07% 和0.18，< 0.001）以及5分钟时阿氏评分< 4分的新生儿比例（0.4% 对0.3%，< 0.001）也更高。妊娠41周引产的死产风险相对于同一孕周的自然分娩增加，并且在调整潜在混杂因素后仍然很高（aOR 1.75；95% CI 1.07 - 2.80，P = 0.025）。妊娠41周的引产组剖宫产率（12.3% 和8.5%，< 0.001）高于妊娠42周的自然分娩组（n = 4548），但真空吸引助产率（8.7% 和9.7%，P = 0.006）低于自然分娩组。
与在相同孕周自然发动分娩的女性相比，对过期妊娠女性在妊娠41周引产可能对母婴结局产生不利影响。妊娠41周引产的不良胎儿结局风险似乎与妊娠42周自然分娩后分娩的女性相似。
