Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term
Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term
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DOI：
10.1097/aog.0b013e3181e10c5c
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发表时间：
2010-07-01
影响因子：
7.2
通讯作者：
Strobino, Donna M.
中科院分区：
文献类型：
--
作者：
Ehrenthal, Deborah B.;Jiang, Xiaozhang;Strobino, Donna M.
目的：为了估计引产与未产妇剖宫产分娩的风险在term在区域hospital.METHODS：这是一个回顾性队列研究未产妇剖宫产分娩的活的，单胎，足月头端妊娠。我们使用的临床数据来自一家大型区域产科医院的电子医院产科记录，近似于一个基于人群的队列。采用多变量logistic回归分析探讨与剖宫产相关的危险因素，并估计了使用引产导致的剖宫产率。结果：从24，679名妇女的队列中，7，804人符合纳入标准。43.6%的病例采用了引产，其中39.9%是选择性的。使用引产与剖宫产的几率增加相关（粗比值比2.67，2.40-2.96），在校正了母亲的人口统计学特征、医疗风险和妊娠并发症后，这种相关性仍然显著（校正比值比1.93，1.71-2.2）。结论：引产对足月初产妇的剖宫产率有显著影响，无论是否有内科或产科并发症。减少选择性引产的使用可能会降低人群的剖宫产率。（妇产科2010;116：35-42）
OBJECTIVE: To estimate the association of labor induction with the risk of a cesarean delivery for nulliparous women presenting at term at a regional hospital.METHODS: This was a retrospective cohort study of cesarean delivery among nulliparous women delivering a live, singleton, vertex pregnancy at term. We used clinical data from electronic hospital obstetric records at a large, regional, obstetric hospital, approximating a population-based cohort. Multivariable logistic regression was used to explore risk factors associated with cesarean delivery, and the fraction of cesarean deliveries attributable to the use of labor induction was estimated.RESULTS: From a cohort of 24,679 women, 7,804 met inclusion criteria. Labor induction was used in 43.6% of cases, 39.9% of which were elective. Use of labor induction was associated with an increased odds of cesarean delivery (crude odds ratio 2.67, 2.40-2.96) and the association remained significant (adjusted odds ratio 1.93, 1.71-2.2) after adjustment for maternal demographic characteristics, medical risk, and pregnancy complications. The contribution of labor induction to cesarean delivery in this cohort was estimated to be approximately 20%.CONCLUSION: Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population. (Obstet Gynecol 2010;116:35-42)