Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study
Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study
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DOI：
10.1515/jpm-2015-0271
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发表时间：
2016-07-01
影响因子：
2.4
通讯作者：
Tul, Natasa
中科院分区：
文献类型：
--
作者：
Lucovnik, Miha;Bregar, Andreja Trojner;Tul, Natasa
目的：调查 26 年来医源性分娩在所有早产中的比例。患者和方法：对 1987 年至 2012 年之间的早产进行登记调查，按分娩时间进行分析：胎膜完整的自发性、胎膜早破 (PPROM) 或医源性。按妊娠期（22周至27周零6天、28周至31周零6天、32周至33周零6天、34周至36周零6天）进行分类。使用Mantel-Haenszel 线性相关卡(2) 检验对早产率进行分析（P < 0.05 显着）。使用逻辑回归来解释潜在的混杂因素。结果：总体早产率为 5.9%（31328 例分娩），其中 28 周完整周之前为 2358 例（0.4%），28 周至 31 周 6 天期间为 3388 例（0.6%），32 周至 33 周 6 天期间为 3970 例（0.8%），以及 21611 例。 (4.1%) 34 周至 36 周 6 天期间，总体早产率有所增加 (P < 0.001)。医源性早产和未足月胎膜早破的发生率随着时间的推移而增加（分别为 P < 0.001 和 P < 0.014）。自发性早产率下降（P < 0.001）。考虑到潜在的混杂因素后，出生年份仍然是所有四个胎龄类别中医源性早产的独立危险因素（P < 0.001）。结论：医源性早产的发生率正在增加，同时自发性早产的发生率正在下降。尝试分析、解释和降低早产率应分别考虑自发性早产和医源性早产。
Objective: To examine the proportion of iatrogenic births among all preterm births over a 26-year period.Patients and methods: A registry-based survey of preterm deliveries between 1987 and 2012 analyzed by the onset of labor: spontaneous with intact membranes, preterm premature rupture of membranes (PPROM) or iatrogenic. Stratification into categories by gestation (22 weeks to 27 weeks and 6 days, 28 weeks to 31 weeks and 6 days, 32 weeks to 33 weeks and 6 days, 34 weeks to 36 weeks and 6 days) was performed. Preterm birth rates were analyzed using the Mantel-Haenszel linear-by-linear association chi(2) test (P < 0.05 significant). Logistic regression was used to account for potential confounders.Results: Overall preterm birth rate was 5.9% (31328 deliveries) including 2358 (0.4%) before 28 completed weeks, 3388 (0.6%) between 28 weeks and 31 weeks 6 days, 3970 (0.8%) between 32 weeks and 33 weeks and 6 days, and 21611 (4.1%) between 34 weeks and 36 weeks and 6 days There was an increase in overall preterm birth rate (P < 0.001). The rate of iatrogenic preterm births and PPROM increased over time (P < 0.001 and P < 0.014, respectively). Rates of spontaneous preterm birth decreased (P < 0.001). After accounting for potential confounders, year of birth remained an independent risk factor for iatrogenic preterm delivery in all four gestational age categories (P < 0.001).Conclusion: The incidence of iatrogenic preterm birth is increasing with a concomitant decrease in the incidence of spontaneous preterm birth. Attempts to analyze, interpret and decrease preterm birth rates should consider spontaneous and iatrogenic preterm births separately.