von Ehr Julia, Wiebking Nina, Kundu Sudip, von Kaisenberg Constantin, Hillemanns Peter, Soergel Philipp
Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany.
Geburtshilfe Frauenheilkd. 2018 Aug;78(8):791-797. doi: 10.1055/a-0637-9400. Epub 2018 Aug 20.
It is known that perinatal mortality is increased with births at night and at the weekend. The aim of the study was to investigate whether there is also an association between the time of delivery (weekday, night, weekend) and perinatal morbidity. All births at Hannover Medical College between 2000 and 2014 were included in a retrospective data analysis. Multiple births, primary sections, severe foetal malformations and intrauterine deaths were not included. A 5-minute Apgar score ≤ 5 and cord arterial pH < 7.10 were defined as perinatal morbidity. Besides the time of delivery, different variables that are regarded as risk factors for increased perinatal morbidity were studied. Univariate logistical regression analysis was performed, followed by multivariate analysis. 18 394 deliveries were included in the study. Pathological prepartum Doppler, medical induction of labour and delivery at night and/or at the weekend significantly increased the probability of an Apgar score ≤ 5 after 5 minutes. The probability that a child will have cord arterial pH < 7.1 post partum is significantly increased with a BMI > 25 before pregnancy, primiparity, medical induction of labour, peripartum administration of oxytocic agents, when the delivery took place at night and weekend combined, but also when the delivery took place at night or at the weekend/on a public holiday. Multivariate regression analysis showed that a time of delivery at night and/or at the weekend or on a public holiday is not a prognostic factor for a 5-minute Apgar score ≤ 5 (p = 0.2377) but is a prognostic factor for cord arterial pH < 7.1 (p = 0.0252). The time of delivery at night or at the weekend/on a public holiday increases the risk for cord arterial pH < 7.1 by ~ 30% compared with delivery on a weekday. However, the time of delivery at night or at the weekend/on a public holiday does not increase the risk for the baby of having a 5-minute Apgar score ≤ 5.
众所周知，夜间和周末分娩会增加围产期死亡率。本研究的目的是调查分娩时间（工作日、夜间、周末）与围产期发病率之间是否也存在关联。对汉诺威医学院2000年至2014年期间的所有分娩进行回顾性数据分析。多胎分娩、初次剖宫产、严重胎儿畸形和宫内死亡不包括在内。5分钟阿氏评分≤5分和脐动脉pH值<7.10被定义为围产期发病率。除分娩时间外，还研究了被视为围产期发病率增加的危险因素的不同变量。进行单因素逻辑回归分析，随后进行多因素分析。本研究纳入了18394例分娩。产前多普勒检查异常、引产以及夜间和/或周末分娩显著增加了5分钟后阿氏评分≤5分的概率。产后脐动脉pH值<7.1的概率在孕前BMI>25、初产、引产、产时使用缩宫剂、夜间和周末联合分娩以及夜间或周末/公共假日分娩时显著增加。多因素回归分析表明，夜间和/或周末或公共假日分娩不是5分钟阿氏评分≤5分的预后因素（p=0.2377），而是脐动脉pH值<7.1的预后因素（p=0.0252）。与工作日分娩相比，夜间或周末/公共假日分娩使脐动脉pH值<7.1的风险增加约30%。然而，夜间或周末/公共假日分娩并不会增加婴儿5分钟阿氏评分≤五分的风险。
