From the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and the Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Obstet Gynecol. 2010 Dec;116(6):1288-1295. doi: 10.1097/AOG.0b013e3181fb7ece.
To compare outcomes among neonates delivered after documentation of fetal lung maturity before 39 weeks and those delivered at 39 or 40 weeks.
This was a retrospective cohort study of women with singleton pregnancy delivered at 36 0/7 to 38 6/7 weeks after positive fetal lung maturity testing (based on amniotic fluid lecithin to sphingomyelin ratio) or at 39 0/7 to 40 6/7 weeks (without maturity testing) at our center from 1999 to 2008. Women with fetuses with major congenital anomalies, cord prolapse, nonreassuring antepartum testing, placental abruption, or oligohydramnios were excluded. A primary composite neonatal outcome included death, adverse respiratory outcomes, hypoglycemia, treated hyperbilirubinemia, generalized seizures, necrotizing enterocolitis, hypoxic ischemic encephalopathy, periventricular leukomalacia, and suspected or proven sepsis.
There were 459 neonates delivered at 36 to 38 weeks and 13,339 delivered at 39 to 40 weeks; mean birth weight was 3,107±548 g and 3,362±439 g, respectively. The risk of the composite adverse neonatal outcome was 6.1% for the 36- to 38-week group compared with 2.5% for the 39- to 40-week group (relative risk 2.4; confidence interval [CI] 1.7-3.5). After multivariable adjustment, early delivery remained significantly associated with an increased risk of the composite outcome (adjusted odds ratio [OR]1.7; CI 1.1-2.6) as well as several individual outcomes, including respiratory distress syndrome (adjusted OR 7.6; CI 2.2-26.6), treated hyperbilirubinemia (adjusted OR 11.2; CI 3.6-34), and hypoglycemia (adjusted OR 5.8; CI 2.4-14.3).
Neonates delivered at 36 to 38 weeks after confirmed fetal lung maturity are at higher risk of adverse outcomes than those delivered at 39 to 40 weeks.
比较胎儿肺成熟度检查在 39 周前记录后分娩的新生儿与 39 或 40 周时分娩的新生儿的结局。
这是一项回顾性队列研究，纳入了 1999 年至 2008 年在我院接受分娩的单胎妊娠孕妇，这些孕妇在 36 0/7 至 38 6/7 周时进行了阳性胎儿肺成熟度检查（基于羊水卵磷脂与鞘磷脂比值）后分娩，或在 39 0/7 至 40 6/7 周时分娩（未进行成熟度检查）。排除胎儿存在重大先天畸形、脐带脱垂、产前检查不乐观、胎盘早剥或羊水过少的孕妇。主要复合新生儿结局包括死亡、呼吸不良结局、低血糖、治疗性高胆红素血症、全身性癫痫发作、坏死性小肠结肠炎、缺氧缺血性脑病、脑室周围白质软化和疑似或证实的败血症。
在 36 至 38 周时分娩的新生儿有 459 例，在 39 至 40 周时分娩的新生儿有 13339 例；平均出生体重分别为 3107±548 g 和 3362±439 g。36 至 38 周组的复合不良新生儿结局风险为 6.1%，而 39 至 40 周组为 2.5%（相对风险 2.4；95%置信区间 [CI] 1.7-3.5）。多变量调整后，早期分娩与复合结局风险增加显著相关（调整后的比值比 [OR] 1.7；95%CI 1.1-2.6），也与一些单一结局相关，包括呼吸窘迫综合征（调整后的 OR 7.6；95%CI 2.2-26.6）、治疗性高胆红素血症（调整后的 OR 11.2；95%CI 3.6-34）和低血糖（调整后的 OR 5.8；95%CI 2.4-14.3）。
经确认胎儿肺成熟后在 36 至 38 周时分娩的新生儿不良结局风险高于在 39 至 40 周时分娩的新生儿。
