Iatrogenic and spontaneous preterm birth in England: A population-based cohort study.
Iatrogenic and spontaneous preterm birth in England: A population-based cohort study.
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英格兰医源性和自发性早产：一项基于人群的队列研究
DOI：
10.1111/1471-0528.17291
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发表时间：
2023-01
影响因子：
5.8
通讯作者：
Pasupathy, Dharmintra
中科院分区：
文献类型：
--
作者：
Aughey, Harriet;Jardine, Jennifer;Knight, Hannah;Gurol-Urganci, Ipek;Walker, Kate;Harris, Tina;van der Meulen, Jan;Hawdon, Jane;Pasupathy, Dharmintra
描述医源性早产和自然早产的发生率和危险因素，以及不同医院之间的发生率差异。使用电子健康记录的队列研究。英国国家医疗服务体系。2015年4月1日至2017年3月31日期间出生的单身子女。多变量Poisson回归模型被用来估计调整后的风险比(AdjRR)，以衡量与母亲人口统计学和临床危险因素的关联。根据分娩方式将早产(孕周37 )定义为医源性或自发性。早产儿占6.1%，其中医源性早产占52.8%。在32 周后，医源性早产的比例增加。这两个亚组都与以前的早产、母亲年龄的极端、社会经济贫困和吸烟有关。医源性早产与较高的体重指数(体重指数40 kg/m2，相对危险度1.59，95%可信区间1.50~1.69)和剖宫产史(相对危险度1.88，95%可信区间1.83~1.95)有关。体重指数较高的妇女(体重指数40 kg/m2，调整相对危险度为0.77，95%可信区间为0.70-0.84)和有剖腹产史的妇女(调整相对危险度为0.87，95%可信区间为0.83-0.90)，自然早产的发生率较低。与自然早产相比，NHS医院信托基金之间医源性分娩的比率差异更大。刚刚超过一半的早产是由医源性干预造成的。医源性分娩与自然早产的母亲人口学和临床危险因素有重叠但不同的模式。因此，应对医源性和自发性亚组进行单独测量和监测，并对其进行总体监测，以便采取不同的预防策略。使用常规获取的医院数据，这是可行的。本文包括作者洞察，视频摘要可在https://vimeo.com/745289966.上找到
To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals. Cohort study using electronic health records. English National Health Service. Singleton births between 1 April 2015 and 31 March 2017. Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors. Preterm births (<37 weeks of gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour. Of the births, 6.1% were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub‐groups were associated with previous preterm birth, extremes of maternal age, socio‐economic deprivation and smoking. Iatrogenic preterm birth was associated with higher body mass index (BMI) (BMI >40 kg/m2 adjRR 1.59, 95% CI 1.50–1.69) and previous caesarean (adjRR 1.88, 95% CI 1.83–1.95). Spontaneous preterm birth was less common in women with a higher BMI (BMI >40 kg/m2 adjRR 0.77, 95% CI 0.70–0.84) and in women with a previous caesarean (adjRR 0.87, 95% CI 0.83–0.90). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared with spontaneous, preterm births. Just over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub‐groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data. This article includes Author Insights, a video abstract available at: https://vimeo.com/745289966.
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DOI：
10.1111/1471-0528.12512
发表时间：
2014-03-01
影响因子：
5.8
作者：
Sharp, A. N.;Alfirevic, Z.
通讯作者：
Alfirevic, Z.
DOI：
10.1111/1471-0528.12508
发表时间：
2014-01-01
影响因子：
5.8
作者：
Knight, H. E.;Gurol-Urganci, I.;Cromwell, D. A.
通讯作者：
Cromwell, D. A.
DOI：
10.1111/1471-0528.13276
发表时间：
2015-10
期刊：
BJOG : an international journal of obstetrics and gynaecology
影响因子：
--
作者：
Oliver-Williams C;Fleming M;Wood AM;Smith G
通讯作者：
Smith G
影响因子：
2.4
作者：
Lucovnik, Miha;Bregar, Andreja Trojner;Tul, Natasa
通讯作者：
Tul, Natasa
影响因子：
7.2
作者：
Cromwell, David. A.;Knight, Hannah. E.;Gurol-Urganci, Ipek
通讯作者：
Gurol-Urganci, Ipek