Brookfield Kathleen F, Osmundson Sarah S, Caughey Aaron B
a Department of Obstetrics and Gynecology , Oregon Health and Science University , Portland , OR , USA.
b Department of Obstetrics and Gynecology , Vanderbilt University School of Medicine, B-1100 Medical Center North , Nashville , TN , USA.
J Matern Fetal Neonatal Med. 2019 Jan;32(2):193-197. doi: 10.1080/14767058.2017.1374364. Epub 2017 Sep 12.
We sought to examine if the method of pregnancy dating at five increasing term gestational ages is associated with increasing neonatal morbidity.
A cohort of women who underwent elective repeat cesarean delivery at ≥37 weeks' gestation were identified from the NICHD MFMU Network registry. We excluded women who were in labor, those carrying a fetus with a congenital anomaly, those with a non-reassuring fetal heart tracing, and those with preeclampsia, preexisting chronic hypertension or diabetes. Composite neonatal morbidity was defined for our study as any of the following: NICU admission, hypotonia, meconium aspiration, seizures, need for ventilator support, NEC, RDS, TTN, hypoglycemia, or neonatal death. We compared composite neonatal morbidity rates among infants born at five different gestational age cutoffs according to their method of pregnancy dating.
At 39 and 40 weeks' gestation, the lowest rate of neonatal complications was seen in pregnancies dated by first trimester ultrasound (5.8% and 5.5%, respectively), while those with the highest neonatal morbidity rates were seen when dated by a second or third trimester ultrasound (8.1% and 6.0%, respectively); p < .001. Additionally within each pregnancy dating category, the neonatal morbidity rates declined from 37 to 40 weeks' gestation and then significantly increased at 41 + 0 weeks' gestation.
Even with suboptimal dating methods, amongst women undergoing elective repeat cesarean delivery, neonatal morbidity was lowest when delivery occurred between 40 and 40 + 6 weeks gestation.
我们试图研究在五个逐渐增加的足月妊娠孕周时的妊娠日期确定方法是否与新生儿发病率增加相关。
从美国国立儿童健康与人类发展研究所母胎医学单位网络登记处识别出一组在≥37周妊娠时接受择期再次剖宫产的妇女。我们排除了正在分娩的妇女、怀有先天性异常胎儿的妇女、胎儿心率监护异常的妇女以及患有子痫前期、既往慢性高血压或糖尿病的妇女。在我们的研究中，复合新生儿发病率定义为以下任何一种情况：入住新生儿重症监护病房、肌张力低下、胎粪吸入、癫痫发作、需要呼吸机支持、坏死性小肠结肠炎、呼吸窘迫综合征、短暂性呼吸急促、低血糖或新生儿死亡。我们根据妊娠日期确定方法比较了在五个不同孕周临界值出生的婴儿的复合新生儿发病率。
在妊娠39周和40周时，通过孕早期超声确定妊娠日期的孕妇中新生儿并发症发生率最低（分别为5.8%和5.5%），而通过孕中期或孕晚期超声确定妊娠日期的孕妇中新生儿发病率最高（分别为8.1%和6.0%）；p <.001。此外，在每个妊娠日期确定类别中，新生儿发病率从妊娠37周下降至40周，然后在妊娠41 + 0周时显著增加。
即使采用不太理想的日期确定方法，在接受择期再次剖宫产的妇女中，妊娠40周至40 + 6周之间分娩时新生儿发病率最低。
