晚期和过期妊娠的围产儿发病率和死亡率。墨西哥 NEOSANO 围产儿网络的经验。

Perinatal morbidity and mortality in late-term and post-term pregnancy. NEOSANO perinatal network's experience in Mexico.

机构信息

Department of Neonatology, Hospital Infantil de Mexico Federico Gomez, México City, México.

出版信息

J Perinatol. 2011 Dec;31(12):789-93. doi: 10.1038/jp.2011.43. Epub 2011 Jun 16.

DOI:10.1038/jp.2011.43

PMID:21681180

Abstract

OBJECTIVE

The objective of this study is to identify adverse perinatal outcomes associated with pregnancies at or beyond 40 weeks.

STUDY DESIGN

Retrospective cohort study conducted in Mexico, with information obtained from the NEOSANO's Perinatal Network Database from April 2006 to April 2009. Multiple births, babies with inaccurate gestational age or babies with congenital malformations were excluded. Logistic regression models were used to analyze perinatal complications associated with pregnancies ≥ 40 weeks.

RESULT

A total of 21 275 babies were analyzed; of these, 4545 (21.3%) were of 40 to 40[frac67] weeks, 3024 (14.2%) 41 to 41[frac67] weeks and 388 (1.8%) 42 to 44 weeks of gestation. Adverse perinatal outcomes associated with 40 to 40[frac67] weeks deliveries were (odds ratio; 95% confidence interval): macrosomia (1.9; 1.5 to 2.6), acute fetal distress (1.4; 1.2 to 1.7), emergency cesarean delivery (1.4; 1.2 to 1.5) and chorioamnionitis (1.4; 1.2 to 1.6). Adverse perinatal outcomes associated with 41 to 41[frac67] weeks were macrosomia (2.5; 1.8 to 3.3), chorioamnionitis (2; 1.7 to 2.3), emergency cesarean delivery (1.8; 1.6 to 2.1) and acute fetal distress (1.4; 1.1 to 1.7). Adverse perinatal outcomes associated with 42 to 44 weeks were macrosomia (7; 4.6 to 10.7), meconium aspiration syndrome (5.6; 2.8 to 11.2), neonatal death (4.8; 1.7 to 13.8), stillbirth (4.3; 1.4 to 13.5), 5' Apgar <4 (4.2; 1.1 to 15.7), chorioamnionitis (2.8; 2.2 to 3.9), admission to neonatal intensive care unit (2.7; 1.5 to 4.8), admission to neonatal intensive care unit or step-down unit (2.4; 1.5 to 3.9), acute fetal distress (1.8; 1.2 to 2.6) and emergency cesarean delivery (1.8; 1.3 to 2.4).

CONCLUSION

An increased risk for perinatal and maternal complications were detected as early as 40 weeks' gestation. The risks of stillbirth and neonatal death were significantly higher in the post-term group than the control group.

摘要

目的

本研究旨在确定与 40 周及以上妊娠相关的不良围产结局。

研究设计

这是在墨西哥进行的一项回顾性队列研究，研究数据来自 2006 年 4 月至 2009 年 4 月 NEOSANO 的围产网络数据库。排除多胎妊娠、胎龄不准确或患有先天性畸形的婴儿。使用逻辑回归模型分析与妊娠≥40 周相关的围产并发症。

结果

共分析了 21275 名婴儿；其中，4545 名（21.3%）为 40 至 40[frac67]周，3024 名（14.2%）为 41 至 41[frac67]周，388 名（1.8%）为 42 至 44 周。与 40 至 40[frac67]周分娩相关的不良围产结局为（比值比；95%置信区间）：巨大儿（1.9；1.5 至 2.6）、急性胎儿窘迫（1.4；1.2 至 1.7）、急诊剖宫产（1.4；1.2 至 1.5）和绒毛膜羊膜炎（1.4；1.2 至 1.6）。与 41 至 41[frac67]周分娩相关的不良围产结局为巨大儿（2.5；1.8 至 3.3）、绒毛膜羊膜炎（2；1.7 至 2.3）、急诊剖宫产（1.8；1.6 至 2.1）和急性胎儿窘迫（1.4；1.1 至 1.7）。与 42 至 44 周分娩相关的不良围产结局为巨大儿（7；4.6 至 10.7）、胎粪吸入综合征（5.6；2.8 至 11.2）、新生儿死亡（4.8；1.7 至 13.8）、死胎（4.3；1.4 至 13.5）、5 分钟 Apgar 评分<4（4.2；1.1 至 15.7）、绒毛膜羊膜炎（2.8；2.2 至 3.9）、新生儿重症监护病房收治（2.7；1.5 至 4.8）、新生儿重症监护病房或降阶病房收治（2.4；1.5 至 3.9）、急性胎儿窘迫（1.8；1.2 至 2.6）和急诊剖宫产（1.8；1.3 至 2.4）。