Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama.
Am J Perinatol. 2018 Jul;35(8):758-763. doi: 10.1055/s-0037-1615792. Epub 2017 Dec 29.
We aim to examine whether outcomes of preterm birth (PTB) are further modified by the indication for delivery.
We performed a retrospective cohort study of all singletons delivered at 23 to 34 weeks from 2011 to 2014. Women were classified by their primary indication for delivery: maternal (preeclampsia) or fetal/obstetric (growth restriction, nonreassuring fetal status, and vaginal bleeding). The primary neonatal outcome was a composite of neonatal death, cord pH <7 or base excess < - 12, 5-minute Apgar ≤3, C-reactive protein during resuscitation, culture-proven sepsis, intraventricular hemorrhage, and necrotizing enterocolitis. Secondary outcomes included the individual components of the primary outcome. Groups were compared using Student's -test and chi-squared tests. Logistic regression was used to adjust for confounding variables.
Of 528 women, 395 (74.8%) were delivered for maternal and 133 (25.2%) for fetal/obstetric indications. Compared with those delivered for a maternal indication, those with a fetal/obstetric indication for delivery had an increased risk of the composite neonatal outcome (adjusted odds ratio [AOR]: 1.9, 95% confidence interval [CI]: 1.13-3.21) and acidemia at birth (AOR: 4.2, 95% CI: 1.89-9.55).
Preterm infants delivered for fetal/obstetric indications have worsened outcomes compared with those delivered for maternal indications. Additional research is needed to further tailor counseling specific to the indication for delivery.
本研究旨在探讨早产（PTB）的结局是否因分娩指征而进一步改变。
本研究为回顾性队列研究，纳入 2011 年至 2014 年间在 23 至 34 周分娩的所有单胎妊娠。根据主要分娩指征将孕妇分为两类：母体（子痫前期）或胎儿/产科（生长受限、胎儿监护不良和阴道出血）。主要新生儿结局为新生儿死亡、脐带血 pH 值<7 或碱剩余<-12、5 分钟 Apgar 评分≤3、复苏时 C 反应蛋白升高、培养阳性败血症、脑室内出血和坏死性小肠结肠炎的复合结局。次要结局包括主要结局的各个组成部分。使用 Student's t 检验和卡方检验比较组间差异。采用逻辑回归校正混杂因素。
在 528 名孕妇中，395 名（74.8%）因母体指征分娩，133 名（25.2%）因胎儿/产科指征分娩。与因母体指征分娩的孕妇相比，因胎儿/产科指征分娩的孕妇复合新生儿结局的风险增加（校正比值比 [AOR]：1.9，95%置信区间 [CI]：1.13-3.21）和出生时酸中毒（AOR：4.2，95% CI：1.89-9.55）的风险增加。
与因母体指征分娩的早产儿相比，因胎儿/产科指征分娩的早产儿结局更差。需要进一步研究，以针对具体的分娩指征进一步调整咨询内容。
