Fetal Medicine Unit and the Department of Paediatrics, Mount Sinai Hospital, the Department of Paediatric Surgery, Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada.
Obstet Gynecol. 2013 May;121(5):990-998. doi: 10.1097/AOG.0b013e31828ec299.
To estimate obstetric and neonatal outcomes after induction of labor at 37 weeks of gestation compared with expectant management in pregnancies complicated by fetal gastroschisis.
The management of 296 pregnancies involving fetal gastroschisis (1980-2011) was reviewed from a single perinatal center. Ultrasound surveillance and nonstress testing were performed every 2 weeks from 30 weeks of gestation, weekly from 34 weeks of gestation, and twice weekly after 35 weeks of gestation until delivery. Labor was induced if fetal well-being testing was abnormal and, since 1994, labor was routinely induced at 37 weeks of gestation.
Of 153 pregnancies reaching 37 weeks of gestation, labor was induced in 77 (26%) and 76 (25.7%) were allowed to labor spontaneously. There were no significant differences in mean maternal age (22 years in both), parity (56% compared with 66% nulliparous), presence of other fetal anomalies (12% compared with 9%), cesarean delivery rate (20% in both), 5-minute Apgar score less than 7 (10% compared with 12%), meconium at birth (36% compared with 49%), or respiratory distress syndrome (16% compared with 7%) between the induced and expectantly managed groups. However, neonatal sepsis (25% compared with 42%; P=.02) and a composite outcome of neonatal death and bowel damage (necrosis, atresia, perforation, adhesion; 8% compared with 21%; P=.02) were more common in expectantly managed pregnancies. Moreover, time to oral feeds (-3.4 days), time on total parenteral nutrition (-6.2 days), and hospital stay (-6.7 days) were reduced when labor was induced.
In fetuses with gastroschisis, induction of labor at 37 weeks of gestation was associated with reduced risks of sepsis, bowel damage, and neonatal death compared with pregnancies managed expectantly beyond 37 weeks of gestation.
II.
比较胎儿先天性腹壁裂孕妇在妊娠 37 周时行引产与期待管理的产科和新生儿结局。
对单中心 1980 年至 2011 年间 296 例胎儿先天性腹壁裂孕妇的管理情况进行回顾性研究。从 30 孕周开始每 2 周进行一次超声监测和非应激试验，从 34 孕周开始每周进行一次，从 35 孕周开始每 2 周进行两次，直至分娩。如果胎儿健康测试异常，将进行引产，自 1994 年以来，常规在妊娠 37 周时进行引产。
在 153 例达到 37 孕周的孕妇中，77 例行引产（26%），76 例自发分娩（25.7%）。两组孕妇的平均年龄（均为 22 岁）、产次（分别为 56%和 66%的初产妇）、其他胎儿异常（分别为 12%和 9%）、剖宫产率（均为 20%）、5 分钟 Apgar 评分＜7（分别为 10%和 12%）、出生时胎粪污染（分别为 36%和 49%）或呼吸窘迫综合征（分别为 16%和 7%）差异均无统计学意义。然而，期待管理组新生儿败血症（25%比 42%；P=.02）和新生儿死亡和肠损伤的复合结局（坏死、闭锁、穿孔、粘连；8%比 21%；P=.02）更为常见。此外，当进行引产时，开始口服喂养的时间（提前 3.4 天）、接受全胃肠外营养的时间（提前 6.2 天）和住院时间（提前 6.7 天）均缩短。
与妊娠 37 周后期待管理相比，胎儿先天性腹壁裂孕妇在妊娠 37 周时行引产与降低败血症、肠损伤和新生儿死亡的风险相关。
II 级。
