Phaloprakarn Chadakarn, Tangjitgamol Siriwan, Manusirivithaya Sumonmal
Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
J Obstet Gynaecol Res. 2016 Aug;42(8):936-43. doi: 10.1111/jog.13016. Epub 2016 Apr 14.
The impact of timing of elective cesarean delivery (CD) at term on maternal and neonatal outcomes among Thai and other Southeast Asian pregnancies was investigated. The rate of spontaneous labor before the scheduled CD, as well as maternal characteristics predicting spontaneous labor, was also evaluated.
Data on maternal and neonatal outcomes of 1221 singleton pregnancies scheduled for either an elective repeat CD or an elective primary CD at 37-40 weeks of gestation were studied. The association between maternal characteristics and the risk of spontaneous labor was evaluated by univariate and multivariate analyses.
There were no significant differences in severe maternal complications between performing an elective CD at 39 weeks and at the other gestational ages. Severe neonatal complications were significantly decreased when a CD was performed electively from 38 weeks onwards. A total of 503 women (41.2 %) went into spontaneous labor before the scheduled CD. Using 39 weeks as the reference group, scheduling a CD at 37 or 38 weeks decreased the risk of spontaneous labor (6.67-fold and 4.55-fold, respectively) while scheduling a CD at 40 weeks had a 2.54-fold increased risk. A history of previous CD and teenage pregnancy were also predictors of spontaneous labor; adjusted odds ratios were 14.27 and 3.93, respectively.
The timing of elective CD at term had impacts on pregnancy outcomes among Thai and other Southeast Asian women. Gestational age at scheduled CD, a previous CD and teenage pregnancy were predictors of spontaneous labor.
研究择期剖宫产（CD）时机对泰国及其他东南亚地区妊娠产妇和新生儿结局的影响。同时评估计划剖宫产之前的自然分娩率以及预测自然分娩的产妇特征。
研究了1221例单胎妊娠产妇的数据，这些产妇计划在妊娠37 - 40周进行择期再次剖宫产或择期初次剖宫产。通过单因素和多因素分析评估产妇特征与自然分娩风险之间的关联。
在39周进行择期剖宫产与在其他孕周进行择期剖宫产相比，严重产妇并发症无显著差异。从38周起进行择期剖宫产时，严重新生儿并发症显著减少。共有503名妇女（41.2%）在计划剖宫产之前出现自然分娩。以39周作为参照组，在37周或38周安排剖宫产降低了自然分娩风险（分别降低6.67倍和4.55倍），而在40周安排剖宫产则使自然分娩风险增加2.54倍。既往剖宫产史和青少年妊娠也是自然分娩的预测因素；调整后的优势比分别为14.27和3.93。
足月择期剖宫产的时机对泰国及其他东南亚地区妇女的妊娠结局有影响。计划剖宫产时的孕周、既往剖宫产史和青少年妊娠是自然分娩的预测因素。
