Schreiber Hanoch, Cohen Gal, Farladansky-Gershnabel Sivan, Sharon-Weiner Maya, Shechter Maor Gil, Biron-Shental Tal, Markovitch Ofer
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428164, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
J Clin Med. 2022 Jun 17;11(12):3480. doi: 10.3390/jcm11123480.
This retrospective cohort study investigated the association between ultrasonographic estimated fetal weight (EFW) and adverse maternal and neonatal outcomes after vacuum-assisted delivery (VAD). It included women with singleton pregnancies at 34−41 weeks gestation, who underwent ultrasonographic pre-labor EFW and VAD in an academic institution, over 6 years. Adverse neonatal and maternal outcomes included shoulder dystocia, clavicular fracture, or third- and fourth-degree perineal tears. A receiver−operator characteristic curve was used to identify the optimal weight cut-off value to predict adverse outcomes. Fetuses above and below this point were compared. Multivariate analysis was used to control for factors that could lead to adverse outcomes. Eight-hundred and fifty women met the inclusion criteria and had sonographic EFW within two-weeks before delivery. Receiver−operator characteristic curve analysis found that ultrasonographic EFW 3666 g is the optimal threshold for adverse outcomes. Based on these results, outcomes were compared using EFW 3700 g. The average EFW in the ≥3700 g group (n = 220, 25.9%) was 3898 ± 154 g (average birthweight 3710 ± 324 g). In the group <3700 g (n = 630, 74.1%), average EFW was 3064 ± 411 g (birthweight 3120 ± 464 g). Shoulder dystocia and clavicular fractures were more frequent in the higher EFW group (6.4% and 2.3% vs. 1.6% and 0.5%, respectively; p < 0.05). Women in the ≥3700 g group experienced more third- and fourth-degree perineal tears (3.2% vs. 1%, p = 0.02). Multivariate logistic regression analysis found maternal age, diabetes and sonographic EFW ≥ 3700 g as independent risk-factors for adverse outcomes. Sonographic EFW ≥ 3700 g is an independent risk-factor for adverse outcomes in VAD. This should be considered when choosing the optimal mode of delivery.
这项回顾性队列研究调查了超声估计胎儿体重（EFW）与真空辅助分娩（VAD）后不良母婴结局之间的关联。研究纳入了妊娠34 - 41周的单胎妊娠女性，这些女性在一所学术机构接受了产前超声EFW检查及VAD，研究时间跨度超过6年。不良新生儿和母亲结局包括肩难产、锁骨骨折或会阴三度和四度撕裂。采用受试者工作特征曲线来确定预测不良结局的最佳体重临界值。对高于和低于该点的胎儿进行比较。采用多变量分析来控制可能导致不良结局 的因素。850名女性符合纳入标准，且在分娩前两周内进行了超声EFW检查。受试者工作特征曲线分析发现，超声EFW 3666 g是不良结局的最佳阈值。基于这些结果，以EFW 3700 g为标准比较结局。≥3700 g组（n = 220，25.9%）的平均EFW为3898±154 g（平均出生体重3710±324 g）。<3700 g组（n = 630，74.1%）的平均EFW为3064±411 g（出生体重3120±464 g）。较高EFW组的肩难产和锁骨骨折更为常见（分别为6.4%和2.3%，而<3700 g组分别为1.6%和0.5%；p<0.05）。≥3700 g组的女性会阴三度和四度撕裂更多见（3.2%对1%，p = 0.02）。多变量逻辑回归分析发现，母亲年龄、糖尿病和超声EFW≥3700 g是不良结局的独立危险因素。超声EFW≥3700 g是VAD不良结局的独立危险因素。在选择最佳分娩方式时应考虑这一点。
