Kazemier B M, Voskamp B J, Ravelli A C J, Pajkrt E, Groot C J M de, Mol B W J
Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Medical Informatics, Academic Medical Centre, Amsterdam, The Netherlands.
Am J Perinatol. 2015 Feb;30(2):177-86. doi: 10.1055/s-0034-1381724. Epub 2014 Jun 10.
Our aim was to study the competing risks of antepartum versus intrapartum/neonatal death in small for gestational age (SGA) and non-SGA fetuses.
We performed a national cohort study using all singletons delivered between 36 and 42(6/7) weeks without hypertension, preeclampsia, diabetes, congenital anomalies, or noncephalic presentation from the Netherlands Perinatal Registry (1999-2007). The resultant cohort was divided in three groups based on birth weight by gestational age (SGA < P5 group, 61,021 deliveries; SGA P5-10 group, 58,902 deliveries; non-SGA group 1,168,523 deliveries). We compared the mortality risk of delivery with expectant management.
Delivery was associated with more mortality than expectant management for 1 week from 39 weeks onward in the non-SGA group (relative risk [RR], 1.26; 95% confidence interval [CI], 1.05-1.50). For the SGA < P5, expectant management for 1 more week was associated with more mortality from 38 weeks onward although this only reached statistical significance from 40 weeks onward (RR, 2.46; 95% CI, 1.80-3.36).
At 36 and 37 weeks, delivery is associated with a higher risk of mortality in SGA < P5 fetuses than expectant management. Delivery of SGA < P5 fetuses at 38 and 39 weeks is associated with the best perinatal outcome whereas for non-SGA fetuses this is at 39 to 40 weeks.
我们的目的是研究小于胎龄（SGA）和非SGA胎儿产前与产时/新生儿死亡的竞争风险。
我们利用荷兰围产期登记处（1999 - 2007年）中36至42（6/7）周分娩的所有单胎进行了一项全国队列研究，这些单胎无高血压、先兆子痫、糖尿病、先天性异常或非头位表现。根据胎龄出生体重将所得队列分为三组（SGA＜第5百分位数组，61,021例分娩；SGA第5至第10百分位数组，58,902例分娩；非SGA组，1,168,523例分娩）。我们比较了分娩与期待管理的死亡风险。
在非SGA组中，从39周起1周内，分娩相关的死亡率高于期待管理（相对风险[RR]，1.26；95%置信区间[CI]，1.05 - 1.50）。对于SGA＜第5百分位数组，从38周起再进行1周的期待管理与更高的死亡率相关，尽管仅从40周起才达到统计学显著性（RR，2.46；95% CI，1.80 - 3.36）。
在36和37周时，SGA＜第5百分位数组胎儿分娩的死亡风险高于期待管理。38和39周时SGA＜第5百分位数组胎儿分娩的围产期结局最佳，而非SGA胎儿在39至40周时围产期结局最佳。
