Quibel T, Raynal P, Bouyer C, Rozenberg P
Département d'obstétrique et gynécologie, Hôpital Poissy-Saint-Germain, Poissy, France; Unité de recherche EA 7285, Université Versailles-Saint-Quentin, Montigny-le-Bretonneux, France.
Département d'obstétrique et gynécologie, centre hospitalier de Versailles André-Mignot, Le-Chesnay, France; Réseau périnatal maternité en Yvelines et périnatalité active, Saint-Germain-en-Laye, France.
Gynecol Obstet Fertil Senol. 2020 Apr;48(4):346-350. doi: 10.1016/j.gofs.2020.01.026. Epub 2020 Feb 1.
To determine the risk of caesarean delivery (CD) when an expectant management is considered for a nulliparous reaching≥37 weeks of gestation (wog).
This is a prospective study, including all nulliparous women who delivered at≥37 wog a singleton fetus in a cephalic presentation between the first January 2017 and the 31st December 2017 in a French perinatal network (Mypa). For each week of gestation from 37 wog to 41 wog, the rate of CD was determined according the onset of labor (spontaneous or induced). The risk of CD when expectant management was considered at a specific gestational age was calculated by taking all the population who reached this gestational age, minus all women who had an induction of labor or underwent a caesarean delivery before labor.
In total, 16,085 women delivered at≥24 wog, and 5498 (34.1%) were nulliparous with a singleton fetus in a cephalic presentation reaching 37SA. The risk of CD increased from 40 wog, whatever the labor was spontaneous or induced (when labor was spontaneous, the risk of CD was stable till 39 wog around 11%, and increased from 14% at 40 wog to 20% at 41 wog; similarly, when labor was induced, the risk of CD was stable till 39 wog around 28%, and increased from 40% at 40 wog to 38% at 41 wog. The risk of CD for a nulliparous reaching>37 Wog when expectant management is considered was stable around 22.3%.
The risk of CD for a nulliparous reaching≥37SA when expectant management is considered is similar than the one in the United States of America.
确定对于妊娠≥37周的初产妇采用期待管理时剖宫产（CD）的风险。
这是一项前瞻性研究，纳入了2017年1月1日至2017年12月31日期间在法国围产期网络（Mypa）中分娩的所有妊娠≥37周、单胎头位的初产妇。对于妊娠37周龄至41周龄的每一周，根据分娩发动情况（自发或引产）确定剖宫产率。在特定孕周考虑期待管理时的剖宫产风险是通过将所有达到该孕周的人群，减去所有在分娩前进行引产或剖宫产的妇女来计算的。
总共16085名妇女在妊娠≥24周龄时分娩，其中5498名（34.1%）是妊娠≥37周、单胎头位的初产妇。无论分娩是自发还是引产，剖宫产风险从40周龄开始增加（当分娩是自发时，剖宫产风险在39周龄之前稳定在11%左右，从40周龄时的14%增加到41周龄时的20%；同样，当分娩是引产时，剖宫产风险在39周龄之前稳定在28%左右，从40周龄时的40%增加到41周龄时的38%）。对于妊娠>37周龄的初产妇，考虑期待管理时的剖宫产风险稳定在22.3%左右。
对于妊娠≥37周龄的初产妇，考虑期待管理时的剖宫产风险与美国的风险相似。
