Reis Zilma Silveira Nogueira, Gaspar Juliano De Souza, Vitral Gabriela Luiza Nogueira, Abrantes Vitor Barbosa, de-Souza Ingrid Michelle Fonseca, Moreira Maria Tereza Silveira, Lopes Pessoa Aguiar Regina Amélia
Center of Health Informatics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
JMIR Pediatr Parent. 2020 Apr 15;3(1):e14109. doi: 10.2196/14109.
The correct dating of pregnancy is critical to support timely decisions and provide obstetric care during birth. The early obstetric ultrasound assessment before 14 weeks is considered the best reference to assist in determining gestational age (GA), with an accuracy of ±5 to 7 days. However, this information is limited in many settings worldwide.
The aim of this study is to analyze the association between the obstetric interventions during childbirth and the quality of GA determination, according to the first antenatal ultrasound assessment, which assisted the calculation.
This is a hospital-based cohort study using medical record data of 2113 births at a perinatal referral center. The database was separated into groups and subgroups of analyses based on the reference used by obstetricians to obtain GA at birth. Maternal and neonatal characteristics, mode of delivery, oxytocin augmentation, and forceps delivery were compared between groups of pregnancies with GA determination at different reference points: obstetric ultrasound assessment 14 weeks, 20 weeks, and ≥20 weeks or without antenatal ultrasound (suboptimal dating). Ultrasound-based GA information was associated with outcomes between the interest groups using chi-square tests, odds ratios (OR) with 95% CI, or the Mann-Whitney statistical analysis.
The chance of nonspontaneous delivery was higher in pregnancies with 14 weeks ultrasound-based GA (OR 1.64, 95% CI 1.35-1.98) and 20 weeks ultrasound-based GA (OR 1.58, 95% CI 1.31-1.90) when compared to the pregnancies with ≥20 weeks ultrasound-based GA or without any antenatal ultrasound. The use of oxytocin for labor augmentation was higher for 14 weeks and 20 weeks ultrasound-based GA, OR 1.41 (95% CI 1.09-1.82) and OR 1.34 (95% CI 1.04-1.72), respectively, when compared to those suboptimally dated. Moreover, maternal blood transfusion after birth was more frequent in births with suboptimal ultrasound-based GA determination (20/657, 3.04%) than in the other groups (14 weeks ultrasound-based GA: 17/1163, 1.46%, P=.02; 20 weeks ultrasound-based GA: 25/1456, 1.71%, P=.048). Cesarean section rates between the suboptimal dating group (244/657, 37.13%) and the other groups (14 weeks: 475/1163, 40.84%, P=.12; 20 weeks: 584/1456, 40.10%, P=.20) were similar. In addition, forceps delivery rates between the suboptimal dating group (17/657, 2.6%) and the other groups (14 weeks: 42/1163, 3.61%, P=.24; 20 weeks: 46/1456, 3.16%, P=.47) were similar. Neonatal intensive care unit admission was more frequent in newborns with suboptimal dating (103/570, 18.07%) when compared with the other groups (14 weeks: 133/1004, 13.25%, P=.01; 20 weeks: 168/1263, 13.30%, P=.01), excluding stillbirths and major fetal malformations.
The present analysis highlighted relevant points of health care to improve obstetric assistance, confirming the importance of early access to technologies for pregnancy dating as an essential component of quality antenatal care.
准确的孕周确定对于支持及时决策以及在分娩期间提供产科护理至关重要。妊娠14周前的早期产科超声评估被认为是辅助确定孕周（GA）的最佳参考，其准确性为±5至7天。然而，在全球许多地区，这一信息有限。
本研究旨在根据首次产前超声评估（该评估辅助计算孕周），分析分娩期间产科干预措施与孕周确定质量之间的关联。
这是一项基于医院的队列研究，使用了一家围产期转诊中心2113例分娩的病历数据。根据产科医生用于获取出生时孕周的参考标准，将数据库分为分析组和亚组。比较了不同参考点确定孕周的妊娠组之间的孕产妇和新生儿特征、分娩方式、缩宫素引产以及产钳助产情况：产科超声评估在14周、20周、≥20周或未进行产前超声检查（孕周确定不佳）。使用卡方检验、95%置信区间的比值比（OR）或曼-惠特尼统计分析，将基于超声的孕周信息与各兴趣组之间的结局进行关联分析。
与基于超声孕周≥20周或未进行任何产前超声检查的妊娠相比，基于超声孕周14周（OR 1.64，95% CI 1.35 - 1.98）和基于超声孕周20周（OR 1.58，95% CI 1.31 - 1.90）的妊娠非自然分娩的几率更高。与孕周确定不佳的情况相比，基于超声孕周14周和20周时使用缩宫素引产的情况更多，OR分别为1.41（95% CI 1.09 - 1.82）和1.34（95% CI 1.04 - 1.72）。此外，基于超声孕周确定不佳的分娩中产后产妇输血情况（20/657，3.04%）比其他组更频繁（基于超声孕周14周：17/
