Besser Limor, Sabag-Shaviv Liat, Yitshak-Sade Maayan, Mastrolia Salvatore Andrea, Landau Danielle, Beer-Weisel Ruthy, Klaitman Vered, Benshalom-Tirosh Neta, Mazor Moshe, Erez Offer
a Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel.
b School of Medicine, Faculty of Health Sciences , Ben Gurion University of the Negev , Be'er Sheva , Israel.
J Matern Fetal Neonatal Med. 2019 Oct;32(19):3278-3287. doi: 10.1080/14767058.2018.1462325. Epub 2018 Apr 26.
In the last few decades, attention has been focused on morbidity and mortality associated with late preterm delivery (34-36 + 6/7 weeks), accounting for 60-70% of all preterm births. This study is aimed to determine (1) the prevalence of late preterm deliveries (spontaneous and medically indicated) in our population; and (2) the rate of neonatal morbidity and mortality as well as maternal complications associated with the different phenotypes of late preterm deliveries. This retrospective population-based cohort study, included 96,176 women who had 257,182 deliveries, occurred between 1988 and 2011, allocated into three groups: term ( = 242,286), spontaneous ( = 10,063), and medically indicated ( = 4833) late preterm deliveries. (1) Medically indicated late preterm deliveries were associated with increased maternal morbidity, as well as neonatal morbidity and mortality, in comparison with other study groups ( < .01 for all comparisons); (2) medically indicated late preterm delivery was an independent risk factor for composite neonatal morbidity (low Apgar score at 5', seizures, asphyxia, acidosis) after adjustment for confounding factors (maternal age and ethnicity and neonatal gender) and stratification according to gestational age at delivery; and (3) the proportion of medically indicated late preterm deliveries affected the neonatal mortality rate. Below 35% of all late preterm deliveries, indicated late preterm birth were associated with a reduction in neonatal mortality; however, above this threshold medically indicated late preterm deliveries were associated with an increased risk for neonatal death. (1) Medically indicated late preterm deliveries were independently associated with adverse composite neonatal outcome; and (2) to benefit in term of neonatal outcome from the tool of medically indicated late preterm birth, their proportion should be kept below 35% of all late preterm deliveries, while exceeding this threshold increases the risk of neonatal mortality.
在过去几十年中，注意力一直集中在与晚期早产（34 - 36⁺⁶/⁷周）相关的发病率和死亡率上，晚期早产占所有早产的60 - 70%。本研究旨在确定：（1）我们研究人群中晚期早产（自发和医学指征性）的患病率；以及（2）与不同类型晚期早产相关的新生儿发病率和死亡率以及孕产妇并发症发生率。这项基于人群的回顾性队列研究纳入了1988年至2011年间分娩257,182次的96,176名妇女，分为三组：足月产（= 242,286次）、自发晚期早产（= 10,063次）和医学指征性晚期早产（= 4,833次）。（1）与其他研究组相比，医学指征性晚期早产与孕产妇发病率以及新生儿发病率和死亡率增加相关（所有比较P < 0.01）；（2）在调整混杂因素（产妇年龄、种族和新生儿性别）并根据分娩时的孕周分层后，医学指征性晚期早产是复合新生儿发病率（5分钟时阿氏评分低、惊厥、窒息、酸中毒）的独立危险因素；（3）医学指征性晚期早产的比例影响新生儿死亡率。在所有晚期早产中，医学指征性晚期早产低于35%时，与新生儿死亡率降低相关；然而，超过此阈值时，医学指征性晚期早产与新生儿死亡风险增加相关。（1）医学指征性晚期早产与不良复合新生儿结局独立相关；（2）为了从医学指征性晚期早产这一手段中获得新生儿结局方面的益处，其比例应保持在所有晚期早产的35%以下，而超过此阈值会增加新生儿死亡风险。
