低危经产妇在妊娠 39-41 周时的母婴不良结局。
Neonatal and Maternal Adverse Outcomes Among Low-Risk Parous Women at 39-41 Weeks of Gestation.
机构信息
Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas; and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
出版信息
Obstet Gynecol. 2019 Aug;134(2):288-294. doi: 10.1097/AOG.0000000000003372.
OBJECTIVE
To compare the composite neonatal or maternal adverse outcome among low-risk, parous women at 39-41 weeks of gestation.
METHODS
This was a retrospective cohort study using the U.S. vital statistics data sets (2012-2016). We evaluated low-risk parous women with nonanomalous singleton gestations who delivered at 39, 40, or 41 weeks of gestation (as reported in completed weeks, eg, 39 weeks includes 39 0/7-39 6/7 weeks of gestation). The primary outcome, the composite neonatal adverse outcome, included any of the following: Apgar score less than 5 at 5 minutes, assisted ventilation for longer than 6 hours, neonatal seizure, or neonatal mortality. The secondary outcome, the composite maternal adverse outcome, included any of the following: intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy. We used multivariable Poisson regression analyses to estimate the association between gestational age and adverse outcome (using adjusted relative risks [aRR] and 95% CI).
RESULTS
Of 19.9 million live births during the study period, 5.4 million (27.1%) met inclusion criteria. Among them, 54.4% delivered at 39 weeks of gestation, 35.7% at 40 weeks, and 9.9% at 41 weeks. The overall rate of the composite neonatal adverse outcome was 4.86 per 1,000 live births. The risk of the composite neonatal adverse outcome was higher for those delivered at 40 (aRR 1.18; 95% CI 1.15-1.22) and 41 (aRR 1.59; 95% CI 1.53-1.65) weeks of gestation when compared with 39 weeks. The overall rate of the composite maternal adverse outcome was 2.31 per 1,000 live births. The risk of the composite maternal adverse outcome was also significantly higher with delivery at 40 (aRR 1.15; 95% CI 1.11-1.19) and 41 weeks of gestation (aRR 1.50; 95% CI 1.42-1.58) than at 39 weeks.
CONCLUSION
Though only modestly, the rates of the composite neonatal and maternal adverse outcomes increase, from 39 through 41 weeks of gestation, among low-risk parous women.
目的
比较低危经产妇在妊娠 39-41 周时的新生儿或产妇复合不良结局。
方法
这是一项使用美国生命统计数据集（2012-2016 年）的回顾性队列研究。我们评估了在妊娠 39、40 或 41 周时分娩的非畸形单胎妊娠的低危经产妇（按完成周数报告，例如，39 周包括 39 0/7-39 6/7 周的妊娠）。主要结局是新生儿复合不良结局，包括以下任何一种情况：5 分钟时 Apgar 评分低于 5 分、辅助通气时间超过 6 小时、新生儿惊厥或新生儿死亡。次要结局是产妇复合不良结局，包括以下任何一种情况：入住重症监护病房、输血、子宫破裂或计划外子宫切除术。我们使用多变量泊松回归分析来估计胎龄与不良结局之间的关联（使用调整后的相对风险[aRR]和 95%置信区间[CI]）。
结果
在研究期间的 1990 万活产儿中，有 540 万（27.1%）符合纳入标准。其中，54.4%在 39 周时分娩，35.7%在 40 周时分娩，9.9%在 41 周时分娩。新生儿复合不良结局的总体发生率为每 1000 例活产儿 4.86 例。与 39 周时相比，40 周（aRR 1.18；95%CI 1.15-1.22）和 41 周（aRR 1.59；95%CI 1.53-1.65）分娩的新生儿复合不良结局风险更高。产妇复合不良结局的总体发生率为每 1000 例活产儿 2.31 例。40 周（aRR 1.15；95%CI 1.11-1.19）和 41 周（aRR 1.50；95%CI 1.42-1.58）分娩的产妇复合不良结局风险也显著高于 39 周。
结论
在低危经产妇中，从 39 周到 41 周，新生儿和产妇复合不良结局的发生率略有增加。
Zotero 插件