描述在重度肥胖与非重度肥胖个体中使用阴道米索前列醇进行引产的特征。
完整摘要 · 中文译文
目的：比较体重指数<40 kg/m²与≥40 kg/m²的个体在足月引产时的引产特征和分娩结局。 研究设计：本二次分析利用了一项整群随机对照试验中阴道米索前列醇组的数据，该试验比较阴道与口服米索前列醇用于引产。纳入妊娠≥37周、宫颈扩张≤2 cm、按标准化方案接受引产的个体。阴道米索前列醇以25 µg剂量每三小时给药一次，最多五剂，随后采用标准化缩宫素方案。我们比较分娩时体重指数<40 kg/m²与≥40 kg/m²个体之间的产程进展，包括产程持续时间、米索前列醇使用情况以及产科和新生儿结局。采用广义估计方程以考虑聚类和合并症。效应量以比值比和调整后平均差及95%置信区间表示。 结果：2021年5月至2022年9月，1,322例患者接受阴道米索前列醇用于足月引产。其中，1,058例（80.0%）体重指数<40 kg/m²，264例（20.0%）体重指数≥40 kg/m²。重度肥胖个体更可能以宫颈未开状态开始引产。在对聚类、初始宫颈扩张、高血压和糖尿病进行调整后，重度肥胖组的引产总持续时间更长（调整后平均差3.5小时，95% CI 1.9-4.8）、第一产程更长（调整后平均差2.2小时，95% CI 0.6-3.8），缩宫素使用持续时间更长（调整后平均差 e 2.5，95% CI 1.1-3.8）。BMI ≥ 40 kg/m2 的个体阴道分娩的几率也较低（aOR 0.6，95% CI 0.4-0.8），并且需要更多剂量的米索前列醇进行引产。 结论：与BMI较低的个体相比，重度肥胖（定义为BMI ≥ 40 kg/m2）与产程时间延长、米索前列醇需求量增加、缩宫素使用时间延长以及阴道分娩几率降低相关。在考虑替代引产方案时，必须权衡该人群中合并症和总体产科发病率增加的情况。
完整摘要 · 英文原文
OBJECTIVE: To compare labor induction characteristics and delivery outcomes among individuals with body mass index < 40 versus ≥ 40 kg/m2 undergoing induction at term. STUDY DESIGN: This secondary analysis utilized data from the vaginal misoprostol arm of a cluster randomized controlled trial comparing vaginal to oral misoprostol for induction. Individuals at ≥ 37 weeks gestation with cervical dilation ≤ 2 cm undergoing induction using a standardized protocol were included. Vaginal misoprostol was given in 25 µg doses every three hours for up to five doses, followed by a standardized oxytocin protocol. We compared labor progression among individuals with BMI < 40 and ≥ 40 kg/m2 at delivery, including labor duration, misoprostol use, and obstetric and neonatal outcomes. Generalized estimating equations were used to account for clustering and comorbid conditions. Effect sizes were presented as odds ratios and adjusted mean differences with 95% confidence intervals. RESULTS: From May 2021 to September 2022, 1,322 patients received vaginal misoprostol for labor induction at term. Among these, 1,058 (80.0%) had a BMI < 40 kg/m2 and 264 (20.0%) had a BMI ≥ 40 kg/m2. Individuals with severe obesity were more likely to start induction with a closed cervix. After adjustment for clustering, initial cervical dilation, hypertension, and diabetes, inductions in the group with severe obesity had longer total durations (adjusted mean difference 3.5h, 95% CI 1.9-4.8), first stage of labor (adjusted mean difference 2.2h, 95% CI 0.6-3.8), and duration of oxytocin use (adjusted mean difference 2.5, 95% CI 1.1-3.8). Individuals with BMI ≥ 40 kg/m2 also had lower odds of vaginal delivery (aOR 0.6, 95% CI 0.4-0.8) and required more doses of misoprostol for induction. CONCLUSION: Severe obesity, defined as BMI ≥ 40 kg/m2, is associated with longer time to delivery, increased misoprostol requirement, longer duration of oxytocin use, and lower odds of vaginal delivery compared to individuals with lower BMI. Consideration of alternative labor induction protocols must be balanced with increased comorbidities and overall obstetric morbidity in this group.