Ducarme Guillaume, Fosse Victoria, Rouger Valérie, Winer Norbert, Flamant Cyril, Olivier Marion
Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche-sur-Yon, France.
Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France.
J Clin Med. 2023 Jul 28;12(15):4970. doi: 10.3390/jcm12154970.
The aim of the study was to determine whether operative vaginal delivery (OVD) was associated with non-optimal neurocognitive development at the corrected age of 2 years for preterm singletons using the Loire Infant Follow-up Team (LIFT) longitudinal cohort, a French regional perinatal network and prospective, population-based cohort of preterm infants. For this study, we included women with cephalic singletons and planned vaginal delivery from 24 to 34 weeks' gestation between 2006 and 2016. The main exposure was the mode of delivery (spontaneous vaginal delivery (SVD), OVD, and cesarean delivery (CS) during labor). The primary outcome was non-optimal neurodevelopmental outcome at the corrected age of 2 years assessed by a physical examination, a neuropsychological test, and/or a parental questionnaire. Secondary outcomes were survival at discharge and survival at discharge without morbidity. We used the multivariate logistic regression and propensity score methods to compare outcomes associated with OVD. The study included 1934 infants born preterm: 1384 (71.6%) with SVD, 87 (4.5%) with OVD, and 463 (23.9%) with CS. Neonates with SVD, OVD, and CS did not differ in survival (97.0%, 97.7%, and 97.8%, respectively; = 0.79) or in survival without morbidity (82.8%, 86.2%, and 82.7%, respectively; = 0.71). In survived infants, 1578 (81.6%) were evaluated at age two: 279 (17.7%) were considered to have a non-optimal neurodevelopmental outcome (18.3% after SVD, 18.0% after OVD, and 15.9% after CS; = 0.57). Propensity score analysis showed that OVD was not associated with non-optimal neurocognitive development at age two, with an adjusted odds ratio (aOR) of 0.86 and a 95% confidence interval (95% CI) of 0.47-1.69, compared with SVD; and an aOR of 0.76 and a 95% CI of 0.31-1.8, compared with CS. Operative vaginal delivery was not associated with non-optimal neurocognitive development at 2 years of corrected age for preterm singletons.
本研究旨在利用卢瓦尔河婴儿随访团队（LIFT）纵向队列（一个法国地区围产期网络以及基于人群的早产儿前瞻性队列），确定单胎早产儿在矫正年龄2岁时，手术阴道分娩（OVD）是否与神经认知发育不理想有关。在本研究中，我们纳入了2006年至2016年间孕周为24至34周、单胎头位且计划经阴道分娩的女性。主要暴露因素为分娩方式（自然阴道分娩（SVD）、手术阴道分娩和分娩时剖宫产（CS））。主要结局是在矫正年龄2岁时通过体格检查、神经心理测试和/或家长问卷评估的神经发育不理想结局。次要结局是出院时存活以及出院时存活且无并发症。我们使用多因素逻辑回归和倾向评分方法比较与手术阴道分娩相关的结局。该研究纳入了1934例早产儿：1384例（71.6%）自然阴道分娩，87例（4.5%）手术阴道分娩，463例（23.9%）剖宫产。自然阴道分娩、手术阴道分娩和剖宫产的新生儿在存活率（分别为97.0%、97.7%和97.8%；P = 0.79）或无并发症存活率（分别为82.8%、86.2%和82.7%；P = 0.71）方面无差异。在存活婴儿中，1578例（81.6%）在2岁时接受了评估：279例（17.7%）被认为神经发育结局不理想（自然阴道分娩后为18.3%；手术阴道分娩后为18.0%；剖宫产后为15.9%；P = 0.57）。倾向评分分析显示，与自然阴道分娩相比，手术阴道分娩与2岁时神经认知发育不理想无关，校正优势比（aOR）为0.86，95%置信区间（95%CI）为0.47 - 1.69；与剖宫产相比，aOR为0.76，95%CI为0.31 - 1.8。对于单胎早产儿，手术阴道分娩与矫正年龄2岁时神经认知发育不理想无关。
