早期早产时不同分娩方式与新生儿死亡率的关系。
Neonatal mortality by attempted route of delivery in early preterm birth.
机构信息
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
出版信息
Am J Obstet Gynecol. 2012 Aug;207(2):117.e1-8. doi: 10.1016/j.ajog.2012.06.023. Epub 2012 Jun 19.
Abstract
OBJECTIVE
We sought to study neonatal outcomes in early preterm births by delivery route.
STUDY DESIGN
Delivery precursors were analyzed in 4352 singleton deliveries, 24 0/7 to 31 6/7 weeks' gestation. In a subset (n = 2906) eligible for a trial of labor, neonatal mortality in attempted vaginal delivery (VD) was compared to planned cesarean delivery stratified by presentation.
RESULTS
Delivery precursors were classified as maternal or fetal conditions (45.7%), preterm premature rupture of membranes (37.7%), and preterm labor (16.6%). For vertex presentation, 79% attempted VD and 84% were successful. There was no difference in neonatal mortality. For breech presentation, at 24 0/7 to 27 6/7 weeks' gestation, 31.7% attempted VD and 27.6% were successful; neonatal mortality was increased (25.2% vs 13.2%, P = .003). At 28 0/7 to 31 6/7 weeks' gestation, 30.5% attempted VD and 17.2% were successful; neonatal mortality was increased (6.0% vs 1.5%, P = .016).
CONCLUSION
Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
摘要
目的
通过分娩方式研究早期早产的新生儿结局。
研究设计
对 4352 例 24 0/7 至 31 6/7 周单胎分娩的分娩前因素进行了分析。在符合试产条件的亚组（n=2906）中，比较了经阴道分娩（VD）尝试与计划性剖宫产的新生儿死亡率，两者按先露情况分层。
结果
分娩前因素分为母体或胎儿情况（45.7%）、胎膜早破（37.7%）和早产临产（16.6%）。对于头位，79%尝试 VD，84%成功。新生儿死亡率无差异。对于臀位，24 0/7 至 27 6/7 周时，31.7%尝试 VD，27.6%成功；新生儿死亡率增加（25.2%比 13.2%，P=.003）。28 0/7 至 31 6/7 周时，30.5%尝试 VD，17.2%成功；新生儿死亡率增加（6.0%比 1.5%，P=.016）。
结论
与臀位不同，头位尝试经阴道分娩成功率高，新生儿死亡率无差异。
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