PDF(Pubmed)
Abstract：
Elective induction of labor at 39 weeks of gestation is common. Thus, there is a need to assess maternal labor-related complications and neonatal outcomes associated with elective induction of labor.
To examine maternal labor-related complications and neonatal outcomes following elective induction of labor at 39 weeks compared with expectant management.
A systematic review of the literature was conducted using the MEDLINE (Ovid), Embase (Ovid), Cochrane Central Library, World Health Organization, and ClinicalTrials.gov databases and registries to search for articles published between database inception and December 8, 2022.
This systematic review and meta-analysis included randomized clinical trials, cohort studies, and cross-sectional studies reporting perinatal outcomes following induction of labor at 39 weeks vs expectant management.
Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Pooled odds ratios (ORs) and 95% CIs were calculated using a random-effects model. This study is reported per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline, and the protocol was prospectively registered with PROSPERO.
Maternal outcomes of interest included emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth. Neonatal outcomes of interest included admission to the neonatal intensive care unit, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia.
Of the 5827 records identified in the search, 14 studies were eligible for inclusion in this review. These studies reported outcomes for 1 625 899 women birthing a singleton pregnancy. Induction of labor at 39 weeks of gestation was associated with a 37% reduced likelihood of third- or fourth-degree perineal injury (OR, 0.63 [95% CI, 0.49-0.81]), in addition to reductions in operative vaginal birth (OR, 0.87 [95% CI, 0.79-0.97]), macrosomia (OR, 0.66 [95% CI, 0.48-0.91]), and low 5-minute Apgar score (OR, 0.62 [95% CI, 0.40-0.96]). Results were similar when confined to multiparous women only, with the addition of a substantial reduction in the likelihood of emergency cesarean section (OR, 0.61 [95% CI, 0.38-0.98]) and no difference in operative vaginal birth (OR, 1.01 [95% CI, 0.84-1.21]). However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia (OR, 1.22 [95% CI, 1.02-1.46]) compared with expectant management.
In this study, induction of labor at 39 weeks was associated with improved maternal labor-related and neonatal outcomes. However, among nulliparous women, induction of labor was associated with shoulder dystocia. These results suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.
To examine maternal labor-related complications and neonatal outcomes following elective induction of labor at 39 weeks compared with expectant management.
A systematic review of the literature was conducted using the MEDLINE (Ovid), Embase (Ovid), Cochrane Central Library, World Health Organization, and ClinicalTrials.gov databases and registries to search for articles published between database inception and December 8, 2022.
This systematic review and meta-analysis included randomized clinical trials, cohort studies, and cross-sectional studies reporting perinatal outcomes following induction of labor at 39 weeks vs expectant management.
Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Pooled odds ratios (ORs) and 95% CIs were calculated using a random-effects model. This study is reported per the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline, and the protocol was prospectively registered with PROSPERO.
Maternal outcomes of interest included emergency cesarean section, perineal injury, postpartum hemorrhage, and operative vaginal birth. Neonatal outcomes of interest included admission to the neonatal intensive care unit, low 5-minute Apgar score (<7) after birth, macrosomia, and shoulder dystocia.
Of the 5827 records identified in the search, 14 studies were eligible for inclusion in this review. These studies reported outcomes for 1 625 899 women birthing a singleton pregnancy. Induction of labor at 39 weeks of gestation was associated with a 37% reduced likelihood of third- or fourth-degree perineal injury (OR, 0.63 [95% CI, 0.49-0.81]), in addition to reductions in operative vaginal birth (OR, 0.87 [95% CI, 0.79-0.97]), macrosomia (OR, 0.66 [95% CI, 0.48-0.91]), and low 5-minute Apgar score (OR, 0.62 [95% CI, 0.40-0.96]). Results were similar when confined to multiparous women only, with the addition of a substantial reduction in the likelihood of emergency cesarean section (OR, 0.61 [95% CI, 0.38-0.98]) and no difference in operative vaginal birth (OR, 1.01 [95% CI, 0.84-1.21]). However, among nulliparous women only, induction of labor was associated with an increased likelihood of shoulder dystocia (OR, 1.22 [95% CI, 1.02-1.46]) compared with expectant management.
In this study, induction of labor at 39 weeks was associated with improved maternal labor-related and neonatal outcomes. However, among nulliparous women, induction of labor was associated with shoulder dystocia. These results suggest that elective induction of labor at 39 weeks may be safe and beneficial for some women; however, potential risks should be discussed with nulliparous women.
摘要：
妊娠39周时择期引产是常见的。因此，有必要评估与择期引产相关的产妇分娩并发症和新生儿结局.
■与期待管理相比，在第39周选择性引产后，检查产妇分娩相关并发症和新生儿结局。
■使用MEDLINE（Ovid）对文献进行了系统回顾，Embase(Ovid),科克伦中央图书馆,世界卫生组织,和ClinicalTrials.gov数据库和注册表，以搜索在数据库开始到2022年12月8日之间发表的文章。
■本系统综述和荟萃分析包括随机临床试验，队列研究，和横断面研究报告39周引产后围产期结局与期待管理。
■两名评审员独立评估研究资格，提取的数据，并评估偏倚研究。使用随机效应模型计算汇总比值比(OR)和95%CI。本研究根据2020年系统评价和荟萃分析指南的首选报告项目进行报告，并且该方案在PROSPERO进行了前瞻性注册。
■产妇感兴趣的结果包括紧急剖宫产，会阴损伤,产后出血,和手术阴道分娩。感兴趣的新生儿结局包括入院新生儿重症监护病房，出生后5分钟Apgar得分低（<7），巨大儿,肩难产.
■在搜索中确定的5827条记录中，14项研究有资格纳入本综述。这些研究报告了1625899名单胎妊娠妇女的结局。妊娠39周时引产与三度或四度会阴损伤的可能性降低37％相关（OR，0.63[95%CI，0.49-0.81])，除了减少手术阴道分娩(OR，0.87[95%CI，0.79-0.97])，巨大儿(或，0.66[95%CI，0.48-0.91])，和低5分钟阿普加得分(或，0.62[95%CI，0.40-0.96]）。当仅限于多胎妇女时，结果是相似的，加上紧急剖宫产的可能性大幅降低(OR，0.61[95%CI，0.38-0.98]）和手术阴道分娩无差异（OR，1.01[95%CI，0.84-1.21]）。然而,仅在未生育妇女中，引产与肩难产的可能性增加相关(OR，1.22[95%CI，1.02-1.46]）与预期管理相比。
■在这项研究中，39周时引产与产妇分娩相关结局和新生儿结局改善相关。然而,在未产妇女中，引产与肩难产有关。这些结果表明，在39周时选择性引产对某些女性可能是安全和有益的；然而，潜在风险应与未分娩妇女讨论。
■与期待管理相比，在第39周选择性引产后，检查产妇分娩相关并发症和新生儿结局。
■使用MEDLINE（Ovid）对文献进行了系统回顾，Embase(Ovid),科克伦中央图书馆,世界卫生组织,和ClinicalTrials.gov数据库和注册表，以搜索在数据库开始到2022年12月8日之间发表的文章。
■本系统综述和荟萃分析包括随机临床试验，队列研究，和横断面研究报告39周引产后围产期结局与期待管理。
■两名评审员独立评估研究资格，提取的数据，并评估偏倚研究。使用随机效应模型计算汇总比值比(OR)和95%CI。本研究根据2020年系统评价和荟萃分析指南的首选报告项目进行报告，并且该方案在PROSPERO进行了前瞻性注册。
■产妇感兴趣的结果包括紧急剖宫产，会阴损伤,产后出血,和手术阴道分娩。感兴趣的新生儿结局包括入院新生儿重症监护病房，出生后5分钟Apgar得分低（<7），巨大儿,肩难产.
■在搜索中确定的5827条记录中，14项研究有资格纳入本综述。这些研究报告了1625899名单胎妊娠妇女的结局。妊娠39周时引产与三度或四度会阴损伤的可能性降低37％相关（OR，0.63[95%CI，0.49-0.81])，除了减少手术阴道分娩(OR，0.87[95%CI，0.79-0.97])，巨大儿(或，0.66[95%CI，0.48-0.91])，和低5分钟阿普加得分(或，0.62[95%CI，0.40-0.96]）。当仅限于多胎妇女时，结果是相似的，加上紧急剖宫产的可能性大幅降低(OR，0.61[95%CI，0.38-0.98]）和手术阴道分娩无差异（OR，1.01[95%CI，0.84-1.21]）。然而,仅在未生育妇女中，引产与肩难产的可能性增加相关(OR，1.22[95%CI，1.02-1.46]）与预期管理相比。
■在这项研究中，39周时引产与产妇分娩相关结局和新生儿结局改善相关。然而,在未产妇女中，引产与肩难产有关。这些结果表明，在39周时选择性引产对某些女性可能是安全和有益的；然而，潜在风险应与未分娩妇女讨论。
