Spain Janine E, Tuuli Methodius, Stout Molly J, Roehl Kimberly A, Odibo Anthony O, Macones George A, Cahill Alison G
Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
Am J Perinatol. 2015 Apr;32(5):497-502. doi: 10.1055/s-0034-1396696. Epub 2014 Dec 24.
The objective of this study was to estimate the association between time from uterine incision to delivery and hypoxic neonatal outcomes in nonanomalous term infants.
All women undergoing in-labor term cesarean deliveries (CDs) in the first 2 years of an ongoing prospective cohort study were included. The primary exposure was time in seconds from uterine incision to delivery. The primary outcome was a composite of hypoxia-associated neonatal outcomes, defined as at least one of: seizures, hypoxic ischemic encephalopathy, need for hypothermia treatment, and death within 7 days.
Of 812 patients who underwent in-labor CD, the composite hypoxia outcome occurred in 18 (2.2%) neonates. There was no significant difference in the rate of hypoxic morbidity with increasing increments of 60 seconds from uterine incision to delivery (p = 0.35). There was a significantly increased risk of hypoxic morbidity in those delivered in the highest quintile (>240 seconds) compared with those in the lowest quintile (≤ 60 seconds) in cesareans performed for an indication other than nonreassuring fetal status (relative risk, 5.58; 95% confidence interval, 1.30-23.91).
Overall, duration from uterine incision to delivery for in-labor cesareans of nonanomalous term infants was not associated with an increase in risk of hypoxia-associated morbidities.
本研究的目的是评估非畸形足月儿从子宫切开到分娩的时间与新生儿缺氧结局之间的关联。
纳入一项正在进行的前瞻性队列研究前两年内所有进行产时足月剖宫产的妇女。主要暴露因素是从子宫切开到分娩的时间（以秒为单位）。主要结局是与缺氧相关的新生儿结局的综合指标，定义为以下至少一项：惊厥、缺氧缺血性脑病、需要进行低温治疗以及7天内死亡。
在812例行产时剖宫产的患者中，18例（2.2%）新生儿出现了综合缺氧结局。从子宫切开到分娩每增加60秒，缺氧发病率无显著差异（p = 0.35）。在因非胎儿窘迫指征而行剖宫产时，最高五分位数组（>240秒）分娩的新生儿与最低五分位数组（≤60秒）相比，缺氧发病风险显著增加（相对风险，5.58；95%置信区间，1.30 - 23.91）。
总体而言，非畸形足月儿产时剖宫产从子宫切开到分娩的持续时间与缺氧相关发病率的增加无关。
