足月分娩的初产妇的一天中不同时段与产科干预的效果、适应证和结局的关系。

Association between time of day and performance, indications, and outcomes of obstetric interventions among nulliparous women delivering at term.

机构信息

Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

出版信息

J Perinatol. 2019 Jun;39(6):808-813. doi: 10.1038/s41372-019-0353-6. Epub 2019 Mar 25.

DOI:10.1038/s41372-019-0353-6

PMID:30911083

Abstract

OBJECTIVE

The objective of this study is to determine whether there is an association between delivery time and obstetric interventions, as well as maternal and perinatal outcomes.

STUDY DESIGN

Retrospective cohort study of nulliparous women delivering singleton, vertex, live births at ≥37 weeks gestation at a single center from 2014 to 2015. Nighttime deliveries were designated as those occurring between 18:00 and 05:59 h. The primary outcomes were obstetrical interventions (cesarean delivery, operative vaginal delivery, episiotomy). Secondary outcomes included indications for operative deliveries, as well as maternal and perinatal outcomes.

RESULTS

Of 7691 women eligible for inclusion, 3707 (48.2%) delivered during the nighttime. Women who experienced nighttime deliveries had no demographic or clinical differences compared with women delivering during the daytime. Women delivering during the nighttime had greater odds of cesarean delivery (OR 1.27, 95% CI 1.14-1.43) and operative vaginal delivery (OR 1.83, 95% CI 1.20-2.78). Women who delivered at night were also more likely to have neonates with a 5 min Apgar score <7 (OR 1.59, 95% CI 1.08-2.32) and umbilical artery pH < 7.0 (OR 1.76, 95% CI 1.18-2.63). There were no differences observed in any of the other outcomes examined.

CONCLUSIONS

Delivery during the nighttime is associated with alterations in some obstetric interventions and perinatal outcomes.

摘要

目的

本研究旨在确定分娩时间与产科干预措施以及母婴围生期结局之间是否存在关联。

研究设计

本研究为回顾性队列研究，纳入 2014 年至 2015 年在单中心分娩的单胎、头位、足月活产的初产妇。夜间分娩定义为 18:00 至 05:59 之间发生的分娩。主要结局为产科干预措施（剖宫产术、经阴道分娩、会阴切开术）。次要结局包括经阴道分娩的指征以及母婴围生期结局。

结果

在符合纳入标准的 7691 名产妇中，有 3707 名（48.2%）在夜间分娩。与日间分娩的产妇相比，夜间分娩的产妇在人口统计学和临床方面无差异。夜间分娩的产妇行剖宫产术的可能性更高（OR 1.27，95%CI 1.14-1.43）和经阴道分娩的可能性更高（OR 1.83，95%CI 1.20-2.78）。夜间分娩的产妇新生儿 5 分钟 Apgar 评分<7 的可能性也更高（OR 1.59，95%CI 1.08-2.32）和脐动脉 pH 值<7.0 的可能性更高（OR 1.76，95%CI 1.18-2.63）。在其他研究的结局中未观察到差异。