Prolonged pregnancy: Induction of labor and cesarean births
Prolonged pregnancy: Induction of labor and cesarean births
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DOI：
10.1016/s0029-7844(01)01354-0
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发表时间：
2001-06-01
影响因子：
7.2
通讯作者：
Leveno, KJ
中科院分区：
文献类型：
--
作者：
Alexander, JM;McIntire, DD;Leveno, KJ
目的：探讨过期妊娠引产对剖宫产的影响。材料与方法：对1997年12月1日至2000年4月4日间足月妊娠41周、42周剖宫产的妇女第1325例进行前瞻性观察研究。比较了自然分娩和引产的妇女的剖宫产率。有任何医疗或产科危险因素的妇女被排除在外。进行功率分析，以确定有多少患者需要显示引产对剖宫产没有影响，贝塔系数为0.8，阿尔法系数为0.05。结果：引导组入院分娩时间较长(5.7小时比11.1小时，P=.001)，且更有可能超过10小时(55小时比24%，P=.001)。诱导组因剖宫产失败而增加了剖宫产率(19例比14%，P<；.001)(14例比8%，P<；.001)。剖宫产的独立危险因素包括未分娩、分娩前宫颈未扩张和硬膜外镇痛。用Logistic回归分析对这些危险因素进行校正，发现增加剖宫产的是危险因素，而不是引产本身。结论：患者自身的危险因素而不是引产本身是导致过期妊娠剖宫产过多的原因。《妇科杂志》2001；97：911-5。(C)2001年由美国妇产科医师学会主办)。
Objective: To determine the effects of labor induction on cesarean delivery in post-date pregnancies.Materials and Methods: A total of 1325 women who reached 41 weeks' gestation between December 1, 1997, and April 4, 2000, and who were scheduled for induction of labor at 42 weeks were included in this prospective observational study. Cesarean delivery rates were compared between those women who entered spontaneous labor and those who underwent induction. Women with any medical or obstetric risk factors were excluded. A power analysis was performed to determine how many patients would be required to show no effect of labor induction on cesarean delivery with a beta of .8 and an alpha of .05. Approximately 5200 patients would be required, taking an estimated 28 years to accrue at our institution.Results: Admission to delivery was longer (5.7 compared with 11.1 hours, P = .001) and more likely to extend beyond 10 hours (55 compared with 24%, P = .001) in the induction group. Cesarean deliveries were increased in the induced group (19 compared with 14%, P < .001) due to cesarean for failure to progress (14 compared with 8%, P < .001). Independent risk factors for cesarean delivery included nulliparity, undilated cervix prior to labor, and epidural analgesia. Correction for these risk factors using logistic regression analysis revealed that it was the risk factors, and not induction of labor per se, that increased cesarean delivery.Conclusion: Risk factors intrinsic to the patient, rather than labor induction itself, are the cause of excess cesarean deliveries in women with prolonged pregnancies. (Obstet Gynecol 2001;97:911-5. (C) 2001 by The American College of Obstetricians and Gynecologists.).