死产女性的分娩方式：死产协作研究网络的结果
Route of Delivery in Women With Stillbirth: Results From the Stillbirth Collaborative Research Network.
作者信息
Boyle Annelee, Preslar Jessica P, Hogue Carol J R, Silver Robert M, Reddy Uma M, Goldenberg Robert L, Stoll Barbara J, Varner Michael W, Conway Deborah L, Saade George R, Bukowski Radek, Dudley Donald J
机构信息
Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, Virginia; the Schools of Medicine and Public Health, Emory University, Atlanta, Georgia; the Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; the Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York; the Department of Pediatrics and Dean's Office, UTHealth McGovern Medical School, Houston, Texas; the Department of Obstetrics and Gynecology, University of Texas School of Medicine-San Antonio, San Antonio, Texas; the Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; and the Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, Texas.
出版信息
Obstet Gynecol. 2017 Apr;129(4):693-698. doi: 10.1097/AOG.0000000000001935.
OBJECTIVE
To describe delivery management of singleton stillbirths in a population-based, multicenter case series.
METHODS
We conducted a retrospective chart review of 611 women with singleton stillbirths at 20 weeks of gestation or greater from March 2006 to September 2008. Medical and delivery information was abstracted from medical records. Both antepartum and intrapartum stillbirths were included; these were analyzed both together and separately. The primary outcome was mode of delivery. Secondary outcomes included induction of labor and indications for cesarean delivery. Indications for cesarean delivery were classified as obstetric (abnormal fetal heart tracing before intrapartum demise, abruption, coagulopathy, uterine rupture, placenta previa, or labor dystocia) or nonobstetric (patient request, repeat cesarean delivery, or not documented).
RESULTS
Of the 611 total cases of stillbirth, 93 (15.2%) underwent cesarean delivery, including 43.0% (46/107) of women with prior cesarean delivery and 9.3% (47/504) of women without prior cesarean delivery. No documented obstetric indication was evident for 38.3% (18/47) of primary and 78.3% (36/46) of repeat cesarean deliveries. Labor induction resulted in vaginal delivery for 98.5% (321/326) of women without prior cesarean delivery and 91.1% (41/45) of women with a history of prior cesarean delivery, including two women who had uterine rupture. Among women with a history of prior cesarean delivery who had spontaneous labor, 74.1% (20/27) delivered vaginally, with no cases of uterine rupture.
CONCLUSION
Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery. However, 15% underwent cesarean delivery, often without a documented obstetric indication.
目的
在一项基于人群的多中心病例系列研究中描述单胎死产的分娩管理情况。
方法
我们对2006年3月至2008年9月期间妊娠20周及以上的611名单胎死产妇女进行了回顾性病历审查。从病历中提取医疗和分娩信息。纳入产前和产时死产病例；对这些病例进行综合分析和单独分析。主要结局是分娩方式。次要结局包括引产和剖宫产指征。剖宫产指征分为产科指征（产时死亡前胎儿心率异常、胎盘早剥、凝血功能障碍、子宫破裂、前置胎盘或产程异常）或非产科指征（患者要求、再次剖宫产或未记录）。
结果
在611例死产病例中，93例（15.2%）接受了剖宫产，其中有剖宫产史的妇女中有43.0%（46/107），无剖宫产史的妇女中有9.3%（47/504）。在初次剖宫产中，38.3%（18/47）和再次剖宫产中78.3%（36/46）无明确记录的产科指征。引产使无剖宫产史的妇女中有98.5%（321/326）和有剖宫产史的妇女中有91.1%（41/45）经阴道分娩，其中包括两名发生子宫破裂的妇女。有剖宫产史且自然发动分娩的妇女中，74.1%（20/27）经阴道分娩，无子宫破裂病例。
结论
死产妇女通常经阴道分娩，无论分娩是自然发动还是引产，也无论其既往是否有剖宫产史。然而，15%的妇女接受了剖宫产，且常常无明确记录的产科指征。
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