Evaluation of outcomes after implementation of an induction-of-labor protocol
Evaluation of outcomes after implementation of an induction-of-labor protocol
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DOI：
10.1016/j.ajog.2014.05.007
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发表时间：
2014-09-01
影响因子：
9.8
通讯作者：
Davidson, Christina
中科院分区：
文献类型：
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作者：
Rhinehart-Ventura, Jessica;Eppes, Catherine;Davidson, Christina
目的：本研究的目的是确定是否遵守引产（IOL）协议降低失败的IOL（FIOL）的比率研究设计：我们进行了为期1年的回顾性图表审查周围的医院IOL协议的实施，并比较产妇和新生儿的分娩结果管理每协议（n - 369）与那些交付，没有（n 230）。纳入了妊娠至少24周且宫颈扩张达2 cm并接受了指定IOL的女性。方案依从性（PA）诱导在开始催产素后24小时内进行剖宫产，在潜伏分娩时放置宫内压力导管，蒙得维的亚单位滴定至200-300或达到足够的宫颈变化，并在剖宫产后至少12小时内给予催产素，然后诊断为FIOL（定义为由于未能进入活跃分娩而在潜伏分娩期间通过剖宫产分娩）。主要结局是FIOL发生率。结果：PA组的FIOL率最低，在产次分层和多变量分析后仍有显著性差异（未经产妇女，3.8% vs 9.8%; P -0.043;经产妇女，0% vs 6%; P <0.0004）。PA组中位分娩时间最短，初产妇为3.5小时（分别为16.0和19.5小时; P = 0.0002），经产妇为1.5小时（分别为10.75和12.25小时; P <0.0001）。有感染发病率或新生儿outcomes.CONCLUSION之间没有差异：坚持一个标准化的人工晶状体协议是与FIOL和劳动长度的下降率。
OBJECTIVE: The purpose of this study was to determine whether adherence to an induction of labor (IOL) protocol decreases the rate of failed IOL (FIOL).STUDY DESIGN: We performed a 1-year retrospective chart review around the implementation of a hospital IOL protocol and compared maternal and neonatal outcomes from deliveries managed per protocol (n - 369) with those deliveries that were not (n 230). Women at least 24 weeks' gestation with cervical dilation up to 2 cm who underwent an indicated IOL were included. Protocol-adherent (PA) inductions had amniotomy within 24 hours of starting oxytocin, intrauterine pressure catheter placement in latent labor, Montevideo units titrated to 200-300 or to adequate cervical change, and oxytocin administered for at least 12 hours after amniotomy before FIOL was diagnosed (defined as delivery by cesarean during latent labor as a result of failure to enter active labor). The primary outcome was the rate of FIOL. Control for possible confounders was made by stratification and multivariate modeling.RESULTS: FIOL rates were lowest in the PA group, which remained significant after stratification on parity and multivariate analysis (nulliparous women, 3.8% vs 9.8%; P - .043; multiparous women, 0% vs 6%; P < .0004). Median time to delivery was shortest in the PA group by 3.5 hours in nulliparous women (16.0 vs 19.5 hours, respectively; P = .0002) and 1.5 hours in multiparous women (10.75 vs 12.25 hours, respectively; P < .0001). There were no differences in infectious morbidity or neonatal outcomes between the groups.CONCLUSION: Adherence to a standardized IOL protocol is associated with a decreased rate of FIOL and length of labor.