Glavind Julie, Henriksen Tine Brink, Kindberg Sara Fevre, Uldbjerg Niels
Department of Obstetrics and Gynecology, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark ; Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Perinatal Epidemiology Research Unit, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark ; Department of Pediatrics, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
PLoS One. 2013 Dec 20;8(12):e84744. doi: 10.1371/journal.pone.0084744. eCollection 2013.
To compare the impact of scheduling caesarean section prior to versus after 39 completed weeks of gestation on the occurrence of unscheduled caesarean section and rescheduling of the procedure.
Secondary analysis from a multicentre randomised open-label trial including singleton pregnant women with a healthy foetus and a reliable due date. Women were allocated by computerized telephone randomisation to planned caesarean section at 38 weeks and three days or 39 weeks and three days. The outcomes were unscheduled deliveries with provided reasons, such as spontaneous labour onset or supervening complications, and any changes in the scheduled delivery date. Statistical analyses were according to intention-to-treat using Fisher's exact test.
From March 2009 to June 2011 1,274 women were included. Median difference in gestational age at delivery was six days. Compared to the 38 weeks group, the women in the 39 weeks group were more likely to have an unscheduled caesarean section (15.2% vs. 9.3%; RR 1.64, 95% CI 1.21; 2.22), to deliver between 6 pm and 8 am (10 % vs. 6%; RR 1.68, 95% CI 1.14; 2.47), or to have the procedure rescheduled (36.7% vs. 23%; RR 1.6, 95% CI 1.34;1.90).
Scheduling caesarean section after 39 weeks leads to a 60% increase in unscheduled caesarean sections and a 70% increase in delivery outside regular work hours as compared to scheduling of the procedure prior to 39 weeks.
www.clinicaltrials.gov NCT00835003 http://www.clinicaltrials.gov/ct2/show/NCT00835003?term=NCT00835003&rank=1.
比较在妊娠满39周之前与之后安排剖宫产对非计划剖宫产的发生率及手术重新安排的影响。
对一项多中心随机开放标签试验进行二次分析，该试验纳入了单胎妊娠且胎儿健康、预产期可靠的孕妇。通过计算机电话随机分组，将孕妇分配至在38周零3天或39周零3天进行计划剖宫产。结局指标为有明确原因的非计划分娩，如自然临产或出现并发症，以及计划分娩日期的任何变化。采用Fisher精确检验按意向性分析进行统计分析。
2009年3月至2011年6月，共纳入1274名女性。分娩时孕周的中位数差异为6天。与38周组相比，39周组的女性更有可能进行非计划剖宫产（15.2%对9.3%；相对危险度1.64，95%置信区间1.21；2.22），在下午6点至上午8点之间分娩（10%对6%；相对危险度1.68，95%置信区间1.14；2.47），或重新安排手术时间（36.7%对23%；相对危险度1.6，95%置信区间1.34；1.90）。
与在39周之前安排剖宫产相比，在39周之后安排剖宫产会导致非计划剖宫产增加60%，非工作时间分娩增加70%。
www.clinicaltrials.gov NCT00835003 http://www.clinicaltrials.gov/ct2/show/NCT00835003?term=NCT00835003&rank=1
