PDF(Pubmed)
Abstract：
UNASSIGNED: Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population.
UNASSIGNED: A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses.
UNASSIGNED: Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3-43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4-28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42-0.58) or no indication (aOR 0.24, 95% CI 0.20-0.28) or with contraindications (aOR 0.12, 95% CI 0.07-0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner\'s occupation) were independently associated with labour induction and augmentation.
UNASSIGNED: Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research.
UNASSIGNED: The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1).
UNASSIGNED: A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses.
UNASSIGNED: Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3-43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4-28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42-0.58) or no indication (aOR 0.24, 95% CI 0.20-0.28) or with contraindications (aOR 0.12, 95% CI 0.07-0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner\'s occupation) were independently associated with labour induction and augmentation.
UNASSIGNED: Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research.
UNASSIGNED: The MaatHRI platform is funded by a Medical Research Council Career Development Award (Grant Ref: MR/P022030/1) and a Transition Support Award (Grant Ref: MR/W029294/1).
摘要：
引产/引产指南涉及评估母体和胎儿的并发症，并允许孕妇做出明智的决定。这项研究旨在全面探索影响印度人口引产和分娩的临床和非临床因素。
■一项前瞻性队列研究包括来自印度13家医院的9305名孕妇。自我报告的产妇社会人口和生活方式因素，在招募时（妊娠≥28周），从医疗记录中获得产妇医疗和产科病史，和妇女在分娩后48小时内随访。根据指南将孕产妇和胎儿的临床信息分为四组临床因素：（i）≥2个适应症，(ii)一个指示，(iii)无适应症及(iv)禁忌症。临床和非临床因素的关联(社会人口统计学，使用多变量逻辑回归分析调查了医疗保健利用和生活方式相关）与引产和增加。
■超过五分之二（n=3936，42.3%，95％置信区间[CI]41.3-43.3％）的研究人群经历了引产和超过四分之一（n=2537，27.3％，95%CI26.4-28.2%）经历了增强。与≥2个适应症的女性相比，那些有一个（调整后比值比[aOR]0.50，95%CI0.42-0.58）或没有适应症（aOR0.24，95%CI0.20-0.28）或有禁忌症（aOR0.12，95%CI0.07-0.20）的患者不太可能被诱导，调整非临床特征。这些关联在增加劳动力方面是相似的。值得注意的是,34%的被诱导或增强的女性没有任何临床指征。几个孕产妇人口(劳动年龄，妊娠早期的胎次和体重指数)，医疗保健利用(产前检查次数，铁叶酸补充剂的持续时间和个人管理分娩)和社会经济因素(宗教，生活在贫困线以下,产妇教育和伴侣的职业）与引产和引产独立相关。
尽管我们在印度研究人群中关于引产和增加分娩的决定主要是由临床建议指导的，我们不能忽视超过三分之一的妇女没有迹象。决策也可能受到需要进一步研究的非临床因素的影响。
MaatHRI平台由医学研究委员会职业发展奖（授予编号：MR/P022030/1）和过渡支持奖（授予编号：MR/W029294/1）资助。
■一项前瞻性队列研究包括来自印度13家医院的9305名孕妇。自我报告的产妇社会人口和生活方式因素，在招募时（妊娠≥28周），从医疗记录中获得产妇医疗和产科病史，和妇女在分娩后48小时内随访。根据指南将孕产妇和胎儿的临床信息分为四组临床因素：（i）≥2个适应症，(ii)一个指示，(iii)无适应症及(iv)禁忌症。临床和非临床因素的关联(社会人口统计学，使用多变量逻辑回归分析调查了医疗保健利用和生活方式相关）与引产和增加。
■超过五分之二（n=3936，42.3%，95％置信区间[CI]41.3-43.3％）的研究人群经历了引产和超过四分之一（n=2537，27.3％，95%CI26.4-28.2%）经历了增强。与≥2个适应症的女性相比，那些有一个（调整后比值比[aOR]0.50，95%CI0.42-0.58）或没有适应症（aOR0.24，95%CI0.20-0.28）或有禁忌症（aOR0.12，95%CI0.07-0.20）的患者不太可能被诱导，调整非临床特征。这些关联在增加劳动力方面是相似的。值得注意的是,34%的被诱导或增强的女性没有任何临床指征。几个孕产妇人口(劳动年龄，妊娠早期的胎次和体重指数)，医疗保健利用(产前检查次数，铁叶酸补充剂的持续时间和个人管理分娩)和社会经济因素(宗教，生活在贫困线以下,产妇教育和伴侣的职业）与引产和引产独立相关。
尽管我们在印度研究人群中关于引产和增加分娩的决定主要是由临床建议指导的，我们不能忽视超过三分之一的妇女没有迹象。决策也可能受到需要进一步研究的非临床因素的影响。
MaatHRI平台由医学研究委员会职业发展奖（授予编号：MR/P022030/1）和过渡支持奖（授予编号：MR/W029294/1）资助。
