Labor Induction versus Expectant Management in Low-Risk Nulliparous Women.
Labor Induction versus Expectant Management in Low-Risk Nulliparous Women.
复制标题
DOI：
10.1056/nejmoa1800566
复制
发表时间：
2018-08-09
期刊：
影响因子：
--
通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network
中科院分区：
文献类型：
--
作者：
Grobman WA;Rice MM;Reddy UM;Tita ATN;Silver RM;Mallett G;Hill K;Thom EA;El-Sayed YY;Perez-Delboy A;Rouse DJ;Saade GR;Boggess KA;Chauhan SP;Iams JD;Chien EK;Casey BM;Gibbs RS;Srinivas SK;Swamy GK;Simhan HN;Macones GA;Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network
在低风险的未分娩妇女中，39周引产对围产期和产妇的影响尚不确定。在这项多中心试验中，我们随机将妊娠38周0天至38周6天的低危未分娩妇女在39周0天至39周4天进行引产或进行期待治疗。主要结果是围产期死亡或严重的新生儿并发症；主要的次要结果是剖腹产。共有3062名妇女被分配进行引产，3044名妇女被分配到孕期管理。引导组和期待管理组的主要结局分别为4.3%和5.4%(相对危险度为0.80；95%可信区间为0.64至1.00)。引产组剖宫产率明显低于期待管理组(18.6%比22.2%；相对危险度0.84；95%可信区间0.76~0.93)。低风险未分娩妇女在39周时引产并没有导致综合不良围产儿结局的发生率显著降低，但它确实导致剖腹产的发生率显著降低。(由尤尼斯·肯尼迪·施莱弗国家儿童健康和人类发展研究所资助；到达临床试验网站编号，NCT01990612。)
The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain. In this multicenter trial, we randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to labor induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal complications; the principal secondary outcome was cesarean delivery. A total of 3062 women were assigned to labor induction, and 3044 were assigned to expectant management. The primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group (relative risk, 0.80; 95% confidence interval [CI], 0.64 to 1.00). The frequency of cesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%; relative risk, 0.84; 95% CI, 0.76 to 0.93). Induction of labor at 39 weeks in low-risk nulliparous women did not result in a significantly lower frequency of a composite adverse perinatal outcome, but it did result in a significantly lower frequency of cesarean delivery. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ARRIVE ClinicalTrials.gov number, NCT01990612.)