Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel.
Reprod Biol Endocrinol. 2010 Jun 21;8:68. doi: 10.1186/1477-7827-8-68.
The literature is nearly unanimous in recommending elective cesarean delivery at 39 weeks of gestation because of the lower rates of neonatal respiratory complications compared to 38 weeks. However, elective cesarean delivery at 39 weeks or more may have maternal and other fetal consequences compared to delivery at 38 weeks, which are not always addressed in these studies.
Between 38 and 39 weeks of gestation, approximately 10% - 14% of women go into spontaneous labor; meaning that a considerable number of women scheduled for an elective cesarean delivery at 39 weeks will deliver earlier in an unscheduled, frequently emergency, cesarean delivery. The incidence of maternal morbidity and mortality is higher among women undergoing non-elective cesarean deliveries than among those undergoing elective ones. Complications may be greater among women after numerous repeat cesarean deliveries and among older women. Other than reducing the frequency of non-elective cesarean deliveries, bringing forward the timing of elective cesarean delivery to 38 weeks, may occasionally prevent intrauterine fetal demise which has been shown to increase with increasing gestational age and to avoid other fetal consequences related to the emergency delivery. All these considerations need to be weighed against the medical and the economic impact of the increase in neonatal morbidity resulting from births at 38 weeks compared to 39 weeks.
Until prospective randomized trials are conducted, we are unlikely to be able to precisely answer all risk:benefit questions as to the best timing of scheduled elective cesarean delivery. Older women, and women with numerous prior cesarean deliveries, are of particular concern. It is reasonable to inform the pregnant women of the risk of each of the above options and to respect her autonomy and decision-making.
文献几乎一致推荐在 39 孕周行择期剖宫产，因为与 38 孕周相比，新生儿呼吸并发症的发生率更低。然而，与 38 孕周分娩相比，39 周或以上行择期剖宫产可能会对产妇和其他胎儿产生影响，但这些研究并未充分讨论这些影响。
在 38 至 39 孕周之间，约 10%-14%的女性会自发分娩；这意味着相当数量的计划在 39 孕周行择期剖宫产的女性会提前进入无计划的紧急剖宫产。与择期剖宫产相比，非择期剖宫产的产妇发病率和死亡率更高。对于多次重复剖宫产的女性和年龄较大的女性，并发症可能更大。除了降低非择期剖宫产的发生率外，将择期剖宫产的时间提前到 38 孕周，可能偶尔会预防胎儿宫内死亡，因为随着胎龄的增加，胎儿宫内死亡的风险增加，并避免与紧急分娩相关的其他胎儿后果。所有这些考虑因素都需要权衡与 38 孕周分娩相比，38 孕周分娩导致的新生儿发病率增加对医疗和经济的影响。
在进行前瞻性随机试验之前，我们不太可能能够准确回答有关最佳择期剖宫产时间的所有风险效益问题。年龄较大的女性和有多次剖宫产史的女性尤其需要关注。告知孕妇上述每种选择的风险是合理的，并尊重她的自主权和决策。
