Monen L, Pop V J, Hasaart T H, Wijnen H, Oei S G, Kuppens S M
Department of Medical Health Psychology, Tilburg University Warandelaan, 2, 5037 AB, Tilburg, The Netherlands.
Department of Obstetrics and Gynaecology, Catharina Hospital, Michelangelolaan 2, 5613 EJ, Eindhoven, The Netherlands.
BMC Pregnancy Childbirth. 2015 Oct 16;15:267. doi: 10.1186/s12884-015-0702-1.
The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries. Secondary aim was to explore whether thyroid function was related to specific reasons for operative deliveries.
In this prospective cohort study, low-risk Caucasian women, pregnant of a single cephalic fetus were included. Women with known auto-immune disease, a pre-labour Caesarean section, induction of labour, breech presentation or preterm delivery were excluded. In all trimesters of pregnancy the thyroid function was assessed. Differences in mean TSH and FT4 were assessed using t-test. Mean TSH and FT4 levels for operative deliveries were determined by one way ANOVA. Repeated measurement analyses were performed (ANOVA), adjusting for BMI, partiy, maternal age and gestational age at delivery.
In total 872 women were included, of which 699 (80.2%) had a spontaneous delivery. At 36 weeks gestation women who had an operative delivery had a significantly higher mean TSH (1.63 mIU/L versus 1.46 mIU/L, p = 0.025) and lower mean FT4 (12.9 pmol/L versus 13.3 pmol/L, p = 0.007)) compared to women who had a spontaneous delivery. Mean TSH was significantly higher (p = 0.026) and mean FT4 significantly lower (p = 0.030) throughout pregnancy for women with an operative delivery due to failure to progress in second stage of labour, compared to women with a spontaneous delivery or operative delivery for other reasons.
Increased TSH and decreased FT4 seem to be associated with more operative vaginal deliveries and Caesarean sections. After adjusting for several confounders the association remained for operative deliveries due to failure to progress in second stage of labour, possibly to be explained by less efficient uterine action.
剖宫产数量的不断增加是现代妇产科学中一个备受关注的重要话题。已知母体甲状腺功能会对许多产科参数产生影响。我们的目的是研究母体甲状腺功能与剖宫产之间可能存在的关系。次要目的是探讨甲状腺功能是否与剖宫产的具体原因相关。
在这项前瞻性队列研究中，纳入了单胎头位妊娠的低风险白种女性。排除患有已知自身免疫性疾病、临产前剖宫产、引产、臀位或早产的女性。在妊娠的所有阶段均评估甲状腺功能。使用t检验评估平均促甲状腺激素（TSH）和游离甲状腺素（FT4）的差异。通过单因素方差分析确定剖宫产的平均TSH和FT4水平。进行重复测量分析（方差分析），并对体重指数（BMI）、产次、产妇年龄和分娩时的孕周进行校正。
总共纳入了872名女性，其中699名（80.2%）顺产。在妊娠36周时，剖宫产的女性平均TSH显著高于顺产女性（1.63 mIU/L对1.46 mIU/L，p = 0.025），平均FT4显著低于顺产女性（12.9 pmol/L对13.3 pmol/L，p = 0.007）。与顺产或因其他原因剖宫产的女性相比，因第二产程进展不顺利而剖宫产的女性在整个孕期的平均TSH显著更高（p = 0.026），平均FT4显著更低（p = 0.030）。
TSH升高和FT4降低似乎与更多的阴道助产和剖宫产相关。在对多个混杂因素进行校正后，因第二产程进展不顺利导致的剖宫产与上述关联仍然存在，这可能是由于子宫收缩效率较低所致。
