中国人群择期剖宫产的最佳时机：上海一项基于大型医院的回顾性队列研究

Optimal timing for elective caesarean delivery in a Chinese population: a large hospital-based retrospective cohort study in Shanghai.

作者信息

Hu Yong, Shen Hong, Landon Mark B, Cheng Weiwei, Liu Xiaohua

机构信息

Department of Neonatology, Shanghai Children's hospital, Shanghai Jiaotong University, Shanghai, China.

Obstetrics Department, International Peace Maternity & Child Health Hospital, Shanghai Jiaotong University, Shanghai, China.

出版信息

BMJ Open. 2017 Jun 8;7(6):e014659. doi: 10.1136/bmjopen-2016-014659.

DOI:10.1136/bmjopen-2016-014659

PMID:28600366

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5623362/

Abstract

OBJECTIVE

To assess the relationship between the timing of antepartum elective caesarean delivery (CD) at term and perinatal outcomes in a Chinese population.

METHODS

We conducted a retrospective cohort study of mode of delivery at a large obstetric centre in Shanghai, China between 2007 and 2014. Eligibility criteria included: term nulliparous women with a singleton gestation undergoing antepartum elective CD.

RESULTS

There were 19 939 women delivered by antepartum CD without indications, with 5.9% performed at 37-37 6/7 weeks, 36.2% at 38-38 6/7 weeks, 38.4% at 39-39 6/7 weeks, 15.4% at 40-40 6/7 weeks, 4.0% at ≥41 weeks. As compared with births at 39-39 6/7 weeks, births at 37 weeks were associated with an increased odds of neonatal respiratory disease (adjusted odds ratian(aOR): 4.82; 95% CI 3.35 to 6.94), neonatal infection (aOR: 3.68; 95% CI 1.80 to 7.52), hypoglycaemia (aOR: 3.85; 95%CI 2.29 to 6.48), hyperbilirubinaemia (aOR: 3.50; 95%CI 2.12 to 5.68), neonatal intensive care admission (aOR: 3.73; 95% CI 2.84 to 4.89) and prolonged hospitalisation (aOR: 7.51; 95% CI 5.10 to 11.07). Births at 38 weeks, 40 weeks or ≥41 weeks were also associated with an increased odds of neonatal respiratory disease with corresponding aORs (95% CI) of 2.26 (1.71 to 3.00), 1.97 (1.33 to 2.94) and 2.91 (1.80 to 4.70), respectively.

CONCLUSION

For women undergoing elective CD, neonatal outcome data suggest that delivery at 39-39 6/7 complete weeks is optimal timing in a Chinese population.

摘要

目的

评估足月前择期剖宫产（CD）时机与中国人群围产期结局之间的关系。

方法

我们对2007年至2014年期间中国上海一家大型产科中心的分娩方式进行了一项回顾性队列研究。纳入标准包括：单胎妊娠的足月未产妇接受产前择期剖宫产。

结果

有19939名妇女接受了无指征的产前剖宫产，其中5.9%在37至37⁶/₇周进行，36.2%在38至38⁶/₇周进行，38.4%在39至39⁶/₇周进行，15.4%在40至40⁶/₇周进行，4.0%在≥41周进行。与39至39⁶/₇周出生的婴儿相比，37周出生的婴儿患新生儿呼吸系统疾病的几率增加（调整后的优势比（aOR）：4.82；95%可信区间3.35至6.94）、新生儿感染（aOR：3.68；95%可信区间1.80至7.52）、低血糖（aOR：3.85；95%可信区间2.29至6.48）、高胆红素血症（aOR：3.50；95%可信区间2.12至5.68）、新生儿重症监护病房入院（aOR：3.73；95%可信区间2.84至4.89）以及住院时间延长（aOR：7.51；95%可信区间5.10至11.07）。38周、40周或≥41周出生的婴儿患新生儿呼吸系统疾病的几率也增加，相应的aOR（95%可信区间）分别为2.26（1.71至3.00）、1.97（1.33至2.94）和2.91（1.80至4.70）。