Kortekaas Joep C, Kazemier Brenda M, Ravelli Anita C J, de Boer Karin, van Dillen Jeroen, Mol BenWillem, de Miranda Esteriek
Radboud University Medical Center, Nijmegen, Department of Obstetrics & Gynaecology, Nijmegen, The Netherlands; Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; Rijnstate Hospital, Department of Obstetrics and Gynaecology, Arnhem, The Netherlands.
Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2015 Oct;193:70-4. doi: 10.1016/j.ejogrb.2015.05.021. Epub 2015 Jun 9.
To assess the recurrence rate of postterm delivery (gestational age at or beyond 42+0 weeks or 294 days) and to describe maternal and perinatal outcomes after previous postterm delivery.
From the longitudinal linked Netherlands Perinatal Registry database, we selected all singleton primiparous women who delivered between 37+0 and 42+6 weeks with a subsequent singleton pregnancy from 1999 to 2007. We excluded congenital abnormalities. We compared the recurrence rate of postterm delivery and risk of antenatal fetal death in women with and without a postterm delivery in their first pregnancy. We compared perinatal outcome (composite of perinatal mortality, Apgar score <7 and birth injury) and adverse maternal outcome (composite of maternal death, abruptio placentae, PPH>1000ml and blood transfusions) between women with a recurrent and a de novo postterm second pregnancy.
Our study population consisted of 233,327 women of whom 17,874 (7.7%) delivered postterm in the first pregnancy. In the second pregnancy, 2678 (15%) women had a recurrent postterm delivery compared to 8698 (4%) women with a de novo postterm delivery (odds ratio (OR) 4.2 95% confidence interval (CI) 4.0-4.4). Subgroup analysis in recurrent and de novo postterm delivery showed no differences in composite perinatal and composite maternal outcome (OR 1.0; CI 0.7-1.5, p=0.90 and OR 1.1, CI 0.9-1.4, p=0.16), adjusted for fetal position and mode of delivery).
Women with a postterm delivery in the first pregnancy have a higher risk of recurrent postterm delivery. Our data suggest that there is no difference in the composite adverse perinatal outcome between recurrent and de novo postterm delivery.
评估过期产（孕周达到或超过42+0周或294天）的复发率，并描述既往有过期产史后的孕产妇及围产期结局。
从纵向关联的荷兰围产期登记数据库中，我们选取了1999年至2007年间孕周在37+0至42+6周之间分娩且随后有单胎妊娠的所有初产妇。我们排除了先天性异常。我们比较了首次妊娠有过期产史和无过期产史的女性中过期产的复发率及产前胎儿死亡风险。我们比较了复发性过期产和初发性过期产的第二次妊娠女性之间的围产期结局（围产期死亡率、阿氏评分<7分和出生损伤的综合指标）及不良孕产妇结局（孕产妇死亡、胎盘早剥、产后出血>1000ml和输血的综合指标）。
我们的研究人群包括233,327名女性，其中17,874名（7.7%）在首次妊娠时为过期产。在第二次妊娠中，2678名（15%）女性有复发性过期产，而8698名（4%）女性为初发性过期产（优势比（OR）4.2，95%置信区间（CI）4.0 - 4.4）。复发性过期产和初发性过期产的亚组分析显示，在调整胎儿位置和分娩方式后，围产期综合结局和孕产妇综合结局无差异（OR 1.0；CI 0.7 - 1.5，p = 0.90；OR 1.1，CI 0.9 - 1.4，p = 0.16）。
首次妊娠有过期产史的女性复发性过期产风险更高。我们的数据表明，复发性过期产和初发性过期产之间的综合不良围产期结局无差异。
