Department of Obstetrics at University of Alabama School of Medicine at Birmingham, Birmingham, AL, USA.
Am J Obstet Gynecol. 2012 Mar;206(3):239.e1-8. doi: 10.1016/j.ajog.2011.12.006. Epub 2011 Dec 16.
The objective of the study was to compare pregnancy outcomes by completed week of gestation after 39 weeks with outcomes at 39 weeks.
Secondary analysis of a multicenter trial of fetal pulse oximetry in spontaneously laboring or induced nulliparous women at a gestation of 36 weeks or longer. Maternal outcomes included a composite (treated uterine atony, blood transfusion, and peripartum infections) and cesarean delivery. Neonatal outcomes included a composite of death, neonatal respiratory and other morbidities, and neonatal intensive care unit admission.
Among the 4086 women studied, the risks of the composite maternal outcome (P value for trend < .001), cesarean delivery (P < .001), and composite neonatal outcome (P = .047) increased with increasing gestational age from 39 to 41 or more completed weeks. Adjusted odds ratios (95% confidence interval) for 40 and 41 or more weeks, respectively, compared with 39 weeks were 1.29 (1.03-1.64) and 2.05 (1.60-2.64) for composite maternal outcome, 1.28 (1.05-1.57) and 1.75 (1.41-2.16) for cesarean delivery, and 1.25 (0.86-1.83) and 1.37 (0.90-2.09) for composite neonatal outcome.
Risks of maternal morbidity and cesarean delivery but not neonatal morbidity increased significantly beyond 39 weeks.
本研究旨在比较 39 周后至 40 周完成妊娠周数的妊娠结局与 39 周的妊娠结局。
对在 36 周或以上自发临产或引产的初产妇中进行胎儿脉搏血氧饱和度多中心试验的二次分析。母体结局包括复合结局（治疗性子宫收缩乏力、输血和围产期感染）和剖宫产。新生儿结局包括死亡、新生儿呼吸和其他并发症以及新生儿重症监护病房入住的复合结局。
在 4086 名研究女性中，复合母体结局（趋势 P 值<.001）、剖宫产（P<.001）和复合新生儿结局（P=0.047）的风险随着妊娠周数从 39 周到 41 周或更长时间的增加而增加。与 39 周相比，40 周和 41 周或更长时间的调整比值比（95%置信区间）分别为复合母体结局 1.29（1.03-1.64）和 2.05（1.60-2.64）、剖宫产 1.28（1.05-1.57）和 1.75（1.41-2.16）以及复合新生儿结局 1.25（0.86-1.83）和 1.37（0.90-2.09）。
超过 39 周后，母体发病率和剖宫产的风险显著增加，但新生儿发病率没有增加。
