Gestational age-specific severe maternal morbidity associated with labor induction

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• 作者：Shiliang Liu ; K.S. Joseph ; Jennifer A. Hutcheon ; Sharon Bartholomew ; Juan Andr¨¦s Le¨®n ; Mark Walker ; Michael S. Kramer ; Robert M. Liston ; Maternal Health Study Group of the Canadian Perinatal Surveillance System
• 关键词：labor induction ; pregnancy complication ; severe maternal morbidity
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：209
• 期：3
• 页码：209.e1-209.e8
• 全文大小：626 K

文摘

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Objective

The purpose of this study was to examine the association between labor induction and gestational age-specific severe maternal morbidity.

Study Design

Our study was restricted to women who delivered singletons at 37-42 weeks' gestation who had no pregnancy complications from 2003-2010 (n?= 1,601,253) in Canada (excluding Quebec). Using a pregnancies-at-risk approach, the week-specific rates of specific morbidity after induction were contrasted with rates among ongoing pregnancies. Logistic regression was used to adjust for confounders.

Results

Induction increased the rate of postpartum hemorrhage that required blood transfusion at 38 weeks' gestation (adjusted rate ratio, 1.28; 95 % confidence interval, 1.11-1.49) and 39 weeks' gestation (adjusted rate ratio, 1.21; 95 % confidence interval, 1.06-1.38). Induction was also associated with higher rates of pueperal sepsis at?38?and 39 weeks' gestation and venous thromboembolism at 38?weeks' gestation. The absolute increase in morbidity rates was small; the number needed to harm was large (eg, 1270 for postpartum hemorrhage with blood transfusion at 38 weeks' gestation).

Conclusion

Among women without pregnancy complications, induction at earlier term is associated with higher rates of specific severe maternal morbidity, although absolute risks are low.