剖宫产决定至切开时间与母婴结局的相关性
The Association of Decision-to-Incision Time for Cesarean Delivery with Maternal and Neonatal Outcomes.
作者信息
Grobman William A, Bailit Jennifer, Sandoval Grecio, Reddy Uma M, Wapner Ronald J, Varner Michael W, Thorp John M, Caritis Steve N, Prasad Mona, Tita Alan T N, Saade George R, Sorokin Yoram, Rouse Dwight J, Blackwell Sean C, Tolosa Jorge E
机构信息
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
出版信息
Am J Perinatol. 2018 Feb;35(3):247-253. doi: 10.1055/s-0037-1606641. Epub 2017 Sep 15.
OBJECTIVE
The objective of this study was to estimate whether the decision-to-incision (DTI) time for cesarean delivery (CD) is associated with differences in maternal and neonatal outcomes.
METHODS
This analysis is of data from women at 25 U.S. medical centers with a term, singleton, cephalic nonanomalous gestation and no prior CD, who underwent an intrapartum CD. Perinatal and maternal outcomes associated with DTI intervals of ≤ 15, 16 to 30, and > 30 minutes were compared.
RESULTS
Among 3,482 eligible women, median DTI times were 46 and 27 minutes for arrest and fetal indications for CD, respectively ( < 0.01). Women with a fetal indication whose DTI interval was > 30 minutes had similar odds to the referent group (DTI of 16-30 minutes) for the adverse neonatal and maternal composites (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.40-1.71 and OR: 0.89, 95% CI: 0.63-1.27). For arrest disorders, the odds of the adverse neonatal composite were lower among women with a DTI of > 30 minutes (OR: 0.25, 95% CI: 0.08-0.77), and the adverse maternal composite was no different (OR: 1.15, 95% CI: 0.81-1.63).
CONCLUSION
In this analysis, DTI times longer than 30 minutes were not associated with worse maternal or neonatal outcomes.
目的
本研究旨在评估剖宫产（CD）的决定至切开（DTI）时间是否与母婴结局差异相关。
方法
本分析采用来自美国25家医疗中心的产妇数据，这些产妇为足月、单胎、头位正常妊娠且既往无剖宫产史，均接受了产时剖宫产。比较了DTI间隔≤15分钟、16至30分钟和>30分钟时的围产期和产妇结局。
结果
在3482名符合条件的女性中，因产程停滞和胎儿指征行剖宫产的DTI中位时间分别为46分钟和27分钟（P<0.01）。DTI间隔>30分钟的胎儿指征女性在不良新生儿和产妇复合结局方面与参照组（DTI为16 - 30分钟）的几率相似（优势比[OR]：0.83，95%置信区间[CI]：0.40 - 1.71；OR：0.89，95%CI：0.63 - 1.27）。对于产程停滞疾病，DTI>30分钟的女性发生不良新生儿复合结局的几率较低（OR：0.25，95%CI：0.08 - 0.77），而不良产妇复合结局无差异（OR：1.15，95%CI：0.81 - 1.63）。
结论
在本分析中，DTI时间超过30分钟与更差的母婴结局无关。
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