Salemi Jason L, Pathak Elizabeth B, Salihu Hamisu M
Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas; and the Department of Community and Family Health, College of Public Health, and the Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida.
Obstet Gynecol. 2016 Apr;127(4):657-666. doi: 10.1097/AOG.0000000000001331.
To compare the risk of neonatal morbidity and infant mortality between elective early-term deliveries and those expectantly managed and delivered at 39 weeks of gestation or greater.
We conducted a population-based retrospective cohort study of 675,302 singleton infants born alive at 37-44 weeks of gestation from 2005 to 2009 in more than 125 birthing facilities in Florida. Data were collected from a validated, longitudinally linked maternal and infant database. The study population was categorized into exposure groups based on the timing and reason for delivery initiation-four subtypes of deliveries at 37-38 weeks of gestation and a comparison group of expectantly managed infants delivered at 39-40 weeks of gestation. Primary outcomes included neonatal respiratory morbidity, sepsis, feeding difficulties, admission to the neonatal intensive care unit (NICU), and infant mortality.
Neonatal outcome rates ranged from 6.0% for respiratory morbidities to 1.3% for both sepsis and feeding difficulties, and the infant mortality rate was 1.5 per 1,000 live births. When compared with infants expectantly managed and delivered at 39-40 weeks of gestation, those delivered after elective induction at 37-38 weeks of gestation did not have increased odds of neonatal respiratory morbidity, sepsis, or NICU admission but did experience slightly higher odds of feeding difficulty (odds ratio 1.18, 99% confidence interval 1.02-1.36). In contrast, infants delivered by elective cesarean at 37-38 weeks of gestation had 13-66% increased odds of adverse outcomes. Survival experiences were similar when comparing early inductions and early cesarean deliveries with the expectant management group.
The issues that surround the timing and reasons for delivery initiation are complicated and each pregnancy unique. This study cautions against a general avoidance of all elective early-term deliveries.
比较择期早产与期待治疗并在孕39周及以上分娩的新生儿发病风险和婴儿死亡率。
我们对2005年至2009年在佛罗里达州125多家分娩机构中孕37 - 44周出生的675302名单胎活产婴儿进行了一项基于人群的回顾性队列研究。数据收集自一个经过验证的、纵向关联的母婴数据库。根据分娩开始的时间和原因，将研究人群分为暴露组——孕37 - 38周分娩的四种亚型，以及一个在孕39 - 40周期待治疗分娩的婴儿对照组。主要结局包括新生儿呼吸疾病、败血症、喂养困难、入住新生儿重症监护病房（NICU）以及婴儿死亡率。
新生儿结局发生率从呼吸疾病的6.0%到败血症和喂养困难的1.3%不等，婴儿死亡率为每1000例活产1.5例。与在孕39 - 40周期待治疗并分娩的婴儿相比，在孕37 - 38周择期引产分娩的婴儿发生新生儿呼吸疾病、败血症或入住NICU的几率并未增加，但喂养困难的几率略高（优势比1.18，99%置信区间1.02 - 1.36）。相比之下，在孕37 - 38周择期剖宫产分娩的婴儿不良结局几率增加了13% - 66%。将早期引产和早期剖宫产与期待治疗组进行比较时，生存情况相似。
围绕分娩开始时间和原因的问题很复杂，每次怀孕情况都不同。本研究提醒不要一概避免所有择期早产。
