足月试产时记录的估计胎儿体重与剖宫产的相关性
Association of Recorded Estimated Fetal Weight and Cesarean Delivery in Attempted Vaginal Delivery at Term.
作者信息
Froehlich Rosemary J, Sandoval Grecio, Bailit Jennifer L, Grobman William A, Reddy Uma M, Wapner Ronald J, Varner Michael W, Thorp John M, Prasad Mona, Tita Alan T N, Saade George, Sorokin Yoram, Blackwell Sean C, Tolosa Jorge E
机构信息
Departments of Obstetrics and Gynecology, Women & Infants Hospital, Brown University, Providence, Rhode Island, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, Columbia University, New York, New York, the University of Utah Health Sciences Center, Salt Lake City, Utah, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, The Ohio State University, Columbus, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, the Oregon Health & Science University, Portland, Oregon; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
出版信息
Obstet Gynecol. 2016 Sep;128(3):487-494. doi: 10.1097/AOG.0000000000001571.
OBJECTIVE
To evaluate the association between documentation of estimated fetal weight, and its value, with cesarean delivery.
METHODS
This was a secondary analysis of a multicenter observational cohort of 115,502 deliveries from 2008 to 2011. Data were abstracted by trained and certified study personnel. We included women at 37 weeks of gestation or greater attempting vaginal delivery with live, nonanomalous, singleton, vertex fetuses and no history of cesarean delivery. Rates and odds ratios (ORs) were calculated for women with ultrasonography or clinical estimated fetal weight compared with women without documentation of estimated fetal weight. Further subgroup analyses were performed for estimated fetal weight categories (less than 3,500, 3,500-3,999, and 4,000 g or greater) stratified by diabetic status. Multivariable analyses were performed to adjust for important potential confounding variables.
RESULTS
We included 64,030 women. Cesarean delivery rates were 18.5% in the ultrasound estimated fetal weight group, 13.4% in the clinical estimated fetal weight group, and 11.7% in the no documented estimated fetal weight group (P<.001). After adjustment (including for birth weight), the adjusted OR of cesarean delivery was 1.44 (95% confidence interval [CI] 1.31-1.58, P<.001) for women with ultrasound estimated fetal weight and 1.08 for clinical estimated fetal weight (95% CI 1.01-1.15, P=.017) compared with women with no documented estimated fetal weight (referent). The highest estimates of fetal weight conveyed the greatest odds of cesarean delivery. When ultrasound estimated fetal weight was 4,000 g or greater, the adjusted OR was 2.15 (95% CI 1.55-2.98, P<.001) in women without diabetes and 9.00 (95% CI 3.65-22.17, P<.001) in women with diabetes compared to those with estimated fetal weight less than 3,500 g.
CONCLUSION
In this contemporary cohort of women attempting vaginal delivery at term, documentation of estimated fetal weight (obtained clinically or, particularly, by ultrasonography) was associated with increased odds of cesarean delivery. This relationship was strongest at higher fetal weight estimates, even after controlling for the effects of birth weight and other factors associated with increased cesarean delivery risk.
目的
评估估计胎儿体重的记录及其数值与剖宫产之间的关联。
方法
这是一项对2008年至2011年115,502例分娩的多中心观察性队列研究的二次分析。数据由经过培训和认证的研究人员提取。我们纳入了妊娠37周及以上、尝试经阴道分娩、胎儿为活产、无畸形、单胎、头位且无剖宫产史的女性。计算有超声或临床估计胎儿体重的女性与无估计胎儿体重记录的女性的剖宫产率和比值比（OR）。对按糖尿病状态分层的估计胎儿体重类别（小于3500 g、3500 - 3999 g以及4000 g及以上）进行进一步的亚组分析。进行多变量分析以调整重要的潜在混杂变量。
结果
我们纳入了64,030名女性。超声估计胎儿体重组的剖宫产率为18.5%，临床估计胎儿体重组为13.4%，无估计胎儿体重记录组为11.7%（P <.001）。调整后（包括出生体重），与无估计胎儿体重记录的女性（参照组）相比，超声估计胎儿体重的女性剖宫产调整后OR为1.44（95%置信区间[CI] 1.31 - 1.58，P <.001），临床估计胎儿体重的女性为1.08（95% CI 1.01 - 1.15，P =.017）。胎儿体重估计值越高，剖宫产的几率越大。当超声估计胎儿体重为4000 g及以上时，与估计胎儿体重小于3500 g的女性相比，无糖尿病女性的调整后OR为2.15（95% CI 1.55 - 2.98，P <.001），糖尿病女性为9.00（95% CI 3.65 - 22.17，P <.001）。
结论
在这个当代足月尝试经阴道分娩的女性队列中，估计胎儿体重的记录（通过临床或特别是超声获得）与剖宫产几率增加相关。即使在控制了出生体重和其他与剖宫产风险增加相关因素的影响后，这种关系在更高的胎儿体重估计值时最为明显。
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