Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Department of Obstetrics and Gynecology, Center Hospitalier Princesse Grace, Monaco, Monaco.
Acta Obstet Gynecol Scand. 2020 Dec;99(12):1682-1690. doi: 10.1111/aogs.13939. Epub 2020 Jul 13.
The objective of this study was to investigate the association between planned mode of delivery and neonatal outcomes with spontaneous very preterm birth among singletons in cephalic presentation.
Etude Epidémiologique sur les Petits Ages Gestationnels 2 is a French national, prospective, population-based cohort study of preterm infants. For this study, we included women with a singleton cephalic pregnancy and spontaneous preterm labor or preterm premature rupture of membranes at 24-31 weeks' gestation. The main exposure was the planned mode of delivery (ie planned vaginal delivery or planned cesarean delivery at the initiation of labor). The primary outcome was survival at discharge and secondary outcome survival at discharge without severe morbidity. Propensity scores were used to minimize indication bias in estimating the association.
The study population consisted of 1008 women: 206 (20.4%) had planned cesarean delivery and 802 (79.6%) planned vaginal delivery. In all, 723 (90.2%) finally had a vaginal delivery. Overall, 187 (92.0%) and 681 (87.0%) neonates in the planned cesarean delivery and planned vaginal delivery groups were discharged alive, and 156 (77.6%) and 590 (76.3%) were discharged alive without severe morbidity. After matching on propensity score, planned cesarean delivery was not associated with survival (adjusted odds ratio [aOR] 1.05, 95% confidence interval [CI] 0.48-2.28) or survival without severe morbidity (aOR 0.64, 95% CI 0.36-1.16).
Planned cesarean delivery for cephalic presentation at 24-31 weeks' gestation after preterm labor or preterm premature rupture of membranes does not improve neonatal outcomes.
本研究旨在探讨计划性分娩方式与自发性极早产分娩头位单胎新生儿结局的关系。
《法国小胎龄儿纵向研究 2 期》是一项法国全国性、前瞻性、基于人群的早产儿队列研究。本研究纳入了妊娠 24-31 周、自发性早产临产或胎膜早破的头位单胎孕妇。主要暴露因素为计划性分娩方式（即临产时计划行阴道分娩或计划性剖宫产）。主要结局为出院时存活，次要结局为无严重并发症存活。采用倾向评分法最小化适应证偏倚对关联的估计。
研究人群包括 1008 名妇女：206 名（20.4%）行计划性剖宫产，802 名（79.6%）行计划性阴道分娩。最终 723 名（90.2%）行阴道分娩。总的来说，计划性剖宫产组和计划性阴道分娩组分别有 187 名（92.0%）和 681 名（87.0%）新生儿出院存活，156 名（77.6%）和 590 名（76.3%）新生儿无严重并发症存活。在倾向评分匹配后，计划性剖宫产与新生儿存活率（校正比值比[aOR]1.05，95%置信区间[CI]0.48-2.28）或无严重并发症存活率（aOR 0.64，95% CI 0.36-1.16）无关。
对于早产临产或胎膜早破的头位单胎妊娠，在 24-31 孕周行计划性剖宫产并不能改善新生儿结局。
