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首页> 外文期刊>Reproductive Health >Management of pregnancy at and beyond 41 completed weeks of gestation in low-risk women: a secondary analysis of two WHO multi-country surveys on maternal and newborn health
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Management of pregnancy at and beyond 41 completed weeks of gestation in low-risk women: a secondary analysis of two WHO multi-country surveys on maternal and newborn health

机译：低危妇女在妊娠41周及以后已完成妊娠管理：对世卫组织两项关于孕产妇和新生儿健康的多国调查的次级分析

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The World Health Organization (WHO) recommends induction of labour (IOL) for women who have reached 41 completed weeks of pregnancy without spontaneous onset of labour. Many women with prolonged pregnancy and/or their clinicians elect not to induce, and chose either elective caesarean section (ECS) or expectant management (EM). This study intended to assess pregnancy outcomes of IOL, ECS and EM at and beyond 41 completed weeks. This study is a secondary analysis of the WHO Global Survey (WHOGS) and the WHO Multi-country Survey (WHOMCS) conducted in Africa, Asia, Latin America and the Middle East. There were 33,003 women with low risk singleton pregnancies at ≥41 completed weeks from 292 facilities in 21 countries. Multilevel logistic regression model was used to assess associations of different management groups with each pregnancy outcome accounted for hierarchical survey design. The results were presented by adjusted odds ratios (aORs) with 95% confidence intervals (CIs) after adjusting for age, education, marital status, parity, previous caesarean section (CS), birth weight, and facility capacity index score. The prevalence of prolonged pregnancy at facility setting in WHOGS, WHOMCS and combined databases were 7.9%, 7.5% and 7.7% respectively. Regarding to maternal adverse outcomes, EM was significantly associated with decreased risk of CS rate consistently in both databases i.e. (aOR0.76; 95% CI: 0.66–0.87) in WHOGS, (aOR0.67; 95% CI: 0.59–0.76) in WHOMCS and (aOR0.70; 95% CI: 0.64–0.77) in combined database, compared to IOL. Regarding the adverse perinatal outcomes, ECS was significantly associated with increased risks of neonatal intensive care unit admission (aOR1.76; 95% CI: 1.28–2.42) in WHOMCS and (aOR1.51; 95% CI: 1.19–1.92) in combined database compared to IOL but not significant in WHOGS database. Compared to IOL, ECS significantly increased risk of NICU admission while EM was significantly associated with decreased risk of CS. ECS should not be recommended for women at 41 completed weeks of pregnancy. However, the choice between IOL and EM should be cautiously considered since the available evidences are still quite limited.
机译：世界卫生组织（世卫组织）建议已怀孕41周而无自发发作的妇女引产。许多怀孕时间较长的妇女和/或其临床医生选择不引诱，并选择了择期剖宫产（ECS）或期待治疗（EM）。这项研究旨在评估41周或以上的IOL，ECS和EM的妊娠结局。这项研究是对在非洲，亚洲，拉丁美洲和中东进行的WHO世界调查（WHOGS）和WHO多国调查（WHOMCS）的二级分析。在21个国家/地区的292家机构中，有33,003名低风险单胎妊娠妇女完成了≥41周的妊娠。多级逻辑回归模型用于评估不同管理组之间的关联，每个妊娠结局均采用分层调查设计。在校正年龄，教育程度，婚姻状况，均等性，先前剖腹产（CS），出生体重和设施容量指数得分后，通过调整后的优势比（aOR）和95％的置信区间（CIs）表示结果。在WHOGS，WHOMCS和组合数据库中，机构设置的长期妊娠患病率分别为7.9％，7.5％和7.7％。关于孕产妇不良结局，在两个数据库中，EM均与持续降低CS率的风险显着相关，即在WHOGS中（aOR0.76; 95％CI：0.66-0.87），（aOR0.67; 95％CI：0.59-0.76）与IOL相比，WHOMCS中的（aOR0.70; 95％CI：0.64-0.77）。关于围产期不良结局，WHOMCS中ECS与新生儿重症监护病房入院风险增加显着相关（aOR1.76; 95％CI：1.28–2.42）和合并使用（aOR1.51; 95％CI：1.19–1.92）数据库与IOL相比，但在WHOGS数据库中不显着。与IOL相比，ECS显着增加了入住NICU的风险，而EM与CS的降低风险显着相关。不建议孕妇在怀孕41周后使用ECS。但是，应谨慎考虑IOL和EM之间的选择，因为现有证据仍然十分有限。

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