Ahimbisibwe Asa, Coughlin Kevin, Eastabrook Genevieve
Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON.
Department of Paediatrics, Division of Neonatal-Perinatal Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON.
J Obstet Gynaecol Can. 2019 Aug;41(8):1144-1149. doi: 10.1016/j.jogc.2018.11.002. Epub 2019 Jan 12.
This study sought to determine the incidence and severity of respiratory morbidity among late preterm and term babies born by elective Caesarean section (CS) in London, Ontario.
A retrospective chart review was conducted of all elective CSs performed at or beyond 36 weeks gestation from June 2010 to June 2014 at London Health Sciences Centre and St. Joseph's Health Care (Canadian Task Force Classification II-2).
The main indications for elective CS were previous CS (59.3%) and malpresentation (24.2%). The majority of elective CSs were performed at 38 weeks (34.1%) and 39 weeks (40.1%). Although only 3.7% of babies born by elective CS were found to have respiratory morbidity, 85% of these babies were admitted to the neonatal intensive care unit (NICU), and 15% required additional observation through a triage period. The relative risk of respiratory morbidity with elective CS at ≤38 weeks compared with ≥39 weeks was 2.14 (P = 0.0110). Only 3.5% of patients received antenatal steroids. There was an increased level of intervention among the babies admitted to the NICU for respiratory morbidity; 47.8%, 19.6%, 60.8%, and 15.25% required oxygen supplement, bag and mask, continuous positive airway pressure, and intubation with mechanical ventilation, respectively.
The risk of respiratory morbidity was significantly higher following elective CS before 39 weeks gestation. This resulted in increased length of stay and increased requirements for intravenous lines, blood draws, and exposure to antibiotics. This study provides further evidence that uncomplicated elective CS should be performed at ≥39 weeks, and interventions, such as preoperative antenatal steroid administration, may be considered if elective CS is medically indicated before 39 weeks.
本研究旨在确定安大略省伦敦市择期剖宫产出生的晚期早产儿和足月儿中呼吸系统疾病的发病率及严重程度。
对2010年6月至2014年6月在伦敦健康科学中心和圣约瑟夫医疗保健中心进行的所有妊娠36周及以后的择期剖宫产进行回顾性病历审查（加拿大工作组分类II - 2）。
择期剖宫产的主要指征为既往剖宫产（59.3%）和胎位异常（24.2%）。大多数择期剖宫产在38周（34.1%）和39周（40.1%）进行。虽然择期剖宫产出生的婴儿中只有3.7%被发现有呼吸系统疾病，但其中85%的婴儿被收入新生儿重症监护病房（NICU），15%需要在分诊期进行额外观察。与≥39周相比，≤38周择期剖宫产发生呼吸系统疾病的相对风险为2.14（P = 0.0110）。只有3.5%的患者接受了产前类固醇治疗。因呼吸系统疾病入住NICU的婴儿干预水平有所增加；分别有47.8%、19.6%、60.8%和15.25%的婴儿需要吸氧、面罩通气、持续气道正压通气和机械通气插管。
妊娠39周前择期剖宫产后呼吸系统疾病的风险显著更高。这导致住院时间延长，静脉输液、采血和接触抗生素的需求增加。本研究进一步证明，无并发症的择期剖宫产应在≥39周进行，如果在39周前有医学指征进行择期剖宫产，可考虑采取术前产前类固醇给药等干预措施。
