Holzer Iris, Lehner Rainer, Ristl Robin, Husslein Peter W, Berger Angelika, Farr Alex
Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Section for Medical Statistics (IMS), Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Wien Klin Wochenschr. 2017 Sep;129(17-18):612-617. doi: 10.1007/s00508-016-1150-2. Epub 2016 Dec 21.
The optimal mode of delivery as a predictor for outcomes in preterm infants is under debate. The purpose of this study was to evaluate the effect of the delivery mode on neonatal outcome among preterm infants in different birthweight categories.
A retrospective analysis of singleton preterm deliveries from 23 + 0 to 33 + 6 gestational weeks was performed. Infants were categorized based on birthweight as large for gestational age (LGA), appropriate for gestational age (AGA) and small for gestational age (SGA). The Apgar score at 5 min served as the main outcome parameter. A sensitivity analysis was performed to adjust for maternal age, parity and fetal malformations as potential confounders.
Out of 1320 singleton preterm infants, 970 (73.5%) were delivered by cesarean section and 350 (26.5%) were delivered vaginally. The AGA infants between 23 + 0 and 27 + 6 weeks showed better outcomes after cesarean section (p < 0.01 from 23 + 0-24 + 6; p = 0.03 from 25 + 0-27 + 6), whereas AGA infants between 31 + 0 and 33 + 6 gestational weeks showed better outcomes after vaginal delivery (p = 0.02). Cesarean section was beneficial in extremely and very preterm SGA infants (p = 0.01 from 25 + 0-27 + 6; p = 0.02 from 28 + 0-30 + 6). The sensitivity analysis showed no confounding effect of other variables.
There is a benefit from cesarean section in AGA preterm infants until 28 weeks of gestation and in SGA preterm infants until 31 weeks of gestation. Vaginal delivery should be chosen for moderately preterm AGA infants.
作为早产儿结局预测指标的最佳分娩方式仍存在争议。本研究旨在评估不同出生体重分类的早产儿分娩方式对新生儿结局的影响。
对孕周为23+0至33+6周的单胎早产分娩进行回顾性分析。根据出生体重将婴儿分为大于胎龄儿（LGA）、适于胎龄儿（AGA）和小于胎龄儿（SGA）。5分钟时的阿氏评分作为主要结局参数。进行敏感性分析以调整产妇年龄、产次和胎儿畸形等潜在混杂因素。
在1320名单胎早产儿中，970例（73.5%）通过剖宫产分娩，350例（26.5%）经阴道分娩。23+0至27+6周的AGA婴儿剖宫产术后结局更好（23+0至24+6周时p<0.01；25+0至27+6周时p=0.03），而31+0至33+6孕周的AGA婴儿经阴道分娩后结局更好（p=0.02）。剖宫产对极早早产和早早产SGA婴儿有益（25+0至27+6周时p=0.01；28+0至30+6周时p=0.02）。敏感性分析显示其他变量无混杂效应。
剖宫产对孕周小于28周的AGA早产儿和孕周小于31周的SGA早产儿有益。对于中度早产AGA婴儿应选择阴道分娩。
