Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavík, Iceland.
J Matern Fetal Neonatal Med. 2021 Oct;34(20):3344-3349. doi: 10.1080/14767058.2019.1684467. Epub 2019 Nov 21.
To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 37-38 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity.
Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥37 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent.
There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 37-38 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥39 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 37-38 weeks gestation compared to 2.4% at 39-42 weeks gestation ( < .001).
Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.
为了将新生儿呼吸窘迫的风险降到最低，建议除非有医学指征，否则择期剖宫产不应在 39 孕周前进行。然而，仍有许多择期剖宫产在早产时（37-38 孕周）进行，而且没有合理的医学指征。本研究评估了 37 孕周以上行择期剖宫产的指征，以评估可能有多少手术可以推迟到≥39 孕周以避免新生儿呼吸窘迫。
在 20 年间，我们收集了所有在人群中通过超声准确确定孕周且行单胎择期剖宫产的产妇和新生儿信息，这些产妇的孕周均≥37 周。将剖宫产指征进行分组，将子宫瘢痕、臀位或横位及孕妇要求列为非紧急情况。
共有 3411 例≥37 孕周的择期剖宫产，其中 790 例（23.2%）在 37-38 孕周。34%（272/790）存在医学指征，但 65.6%（518/790）可能推迟到≥39 孕周。如果在 37-38 孕周分娩，5.7%的新生儿会发生呼吸窘迫，而在 39-42 孕周分娩，这一比例为 2.4%（<0.001）。
在 39 孕周前的择期剖宫产中，三分之二没有明确的医学指征，这使新生儿面临呼吸窘迫的风险增加。在≥39 孕周时安排择期剖宫产对于降低新生儿呼吸窘迫的风险很重要，除非有明确的医学指征需要提前分娩。
