Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Am J Obstet Gynecol. 2012 Aug;207(2):117.e1-8. doi: 10.1016/j.ajog.2012.06.023. Epub 2012 Jun 19.
We sought to study neonatal outcomes in early preterm births by delivery route.
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.
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).
Attempted VD for vertex presentation has a high success rate with no difference in neonatal mortality unlike breech presentation.
通过分娩方式研究早期早产的新生儿结局。
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。
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）。
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。
