Treger M, Hallak M, Silberstein T, Friger M, Katz M, Mazor M
Department of Obstetrics and Gynecology, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Matern Fetal Neonatal Med. 2002 Jan;11(1):50-3. doi: 10.1080/jmf.11.1.50.53.
To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor.
A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves.
The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section.
The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.
确定孕39周后低风险妊娠中母胎并发症的发生率，并重新评估引产的可接受截止孕周（42周）。
回顾性评估36160例孕周确定可靠（末次月经及早期超声检查）的低风险妊娠，以评估母胎并发症，包括产程无进展、宫颈撕裂、胎盘残留、产后出血、真空吸引分娩、剖宫产、巨大儿、羊水粪染、胎儿心率监测异常及产前、产时和产后死亡。采用单因素和多因素分析及受试者工作特征曲线比较不同孕周的妊娠结局。
单因素分析发现，随着孕周增加，第一产程和第二产程产程无进展、胎盘残留、真空吸引分娩、剖宫产、巨大儿、羊水粪染及胎儿心率监测异常的发生率显著升高。对这些参数进行多因素分析后发现，以下情况发生率显著升高：第一产程和第二产程产程无进展、巨大儿、羊水粪染及剖宫产。统计分析（受试者工作特征曲线）显示，妊娠满42周后产程无进展风险显著升高，妊娠满41周后巨大儿、羊水粪染及剖宫产风险显著升高。
随着孕周增加，第一产程和第二产程产程无进展、羊水粪染、巨大儿及剖宫产的发生率显著升高。为降低巨大儿、羊水粪染及剖宫产的发生率，我们建议在42周前考虑引产。
