足月单胎再次剖宫产分娩时机与不良结局。
Timing of delivery and adverse outcomes in term singleton repeat cesarean deliveries.
机构信息
Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, The Ohio State University, Columbus, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, University of Utah, Salt Lake City, Utah, University of Pittsburgh, Pittsburgh, Pennsylvania, Wayne State University, Detroit, Michigan, University of Miami, Miami, Florida, University of Tennessee, Memphis, Tennessee, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, The University of Texas Health Science Center at Houston, Houston, Texas, and Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; The George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2013 Mar;121(3):561-569. doi: 10.1097/AOG.0b013e3182822193.
OBJECTIVE
To compare the maternal and neonatal risks of elective repeat cesarean delivery compared with pregnancy continuation at different gestational ages, starting from 37 weeks.
METHODS
We analyzed the composite maternal and neonatal outcomes of repeat cesarean deliveries studied prospectively over 4 years at 19 U.S. centers. Maternal outcome was a composite of pulmonary edema, cesarean hysterectomy, pelvic abscess, thromboembolism, pneumonia, transfusion, or death. Composite neonatal outcome consisted of respiratory distress, transient tachypnea, necrotizing enterocolitis, sepsis, ventilation, seizure, hypoxic-ischemic encephalopathy, neonatal intensive care unit admission, 5-minute Apgar of 3 or lower, or death. Outcomes after elective repeat cesarean delivery without labor at each specific gestational age were compared with outcomes for all who were delivered later as a result of labor onset, specific obstetric indications, or both.
RESULTS
Twenty-three thousand seven hundred ninety-four repeat cesarean deliveries were included. Elective delivery at 37 weeks of gestation had significantly higher risks of adverse maternal outcome (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.06-2.31), whereas elective delivery at 39 weeks of gestation was associated with better maternal outcome when compared with pregnancy continuation (OR 0.51, 95% CI 0.36-0.72). Elective repeat cesarean deliveries at 37 and 38 weeks of gestation had significantly higher risks of adverse neonatal outcome (37 weeks OR 2.02, 95% CI 1.73-2.36; 38 weeks OR 1.39 95% CI 1.24-1.56), whereas delivery at 39 and 40 weeks of gestation presented better neonatal outcome as opposed to pregnancy continuation (39 weeks OR 0.79, 95% CI 0.68-0.92; 40 weeks OR 0.57, 95% CI 0.43-0.75).
CONCLUSION
In women with prior cesarean delivery, 39 weeks of gestation is the optimal time for repeat cesarean delivery for both mother and neonate.
目的
比较在不同孕周（37 周起）行选择性再次剖宫产与继续妊娠的母婴风险。
方法
我们分析了 4 年来在 19 个美国中心前瞻性研究的再次剖宫产的复合母婴结局。母体结局是肺水肿、剖宫产子宫切除术、骨盆脓肿、血栓栓塞、肺炎、输血或死亡的复合结局。复合新生儿结局包括呼吸窘迫、短暂性呼吸急促加快、新生儿坏死性小肠结肠炎、败血症、通气、癫痫发作、缺氧缺血性脑病、新生儿重症监护病房入院、5 分钟 Apgar 评分为 3 分或更低，或死亡。在特定的妊娠周数时无临产而行选择性再次剖宫产的结局与因临产、特定产科指征或两者皆有而行剖宫产的所有患者的结局进行比较。
结果
纳入了 23794 例再次剖宫产。37 孕周选择性分娩与不良母体结局的风险显著增加（比值比[OR] 1.56，95%置信区间[CI] 1.06-2.31），而与继续妊娠相比，39 孕周选择性分娩与更好的母体结局相关（OR 0.51，95% CI 0.36-0.72）。37 周和 38 孕周选择性再次剖宫产与不良新生儿结局的风险显著增加相关（37 孕周 OR 2.02，95% CI 1.73-2.36；38 孕周 OR 1.39，95% CI 1.24-1.56），而 39 周和 40 孕周分娩与继续妊娠相比有更好的新生儿结局（39 孕周 OR 0.79，95% CI 0.68-0.92；40 孕周 OR 0.57，95% CI 0.43-0.75）。
结论
对于有剖宫产史的女性，39 孕周是再次行剖宫产的最佳时机，对母婴均有益。
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