Morrison J J, Rennie J M, Milton P J
Department of Obstetrics and Gynaecology, University College London Medical School, UK.
Br J Obstet Gynaecol. 1995 Feb;102(2):101-6. doi: 10.1111/j.1471-0528.1995.tb09060.x.
To establish whether the timing of delivery between 37 and 42 weeks gestation influences neonatal respiratory outcome and thus provide information which can be used to aid planning of elective delivery at term.
All cases of respiratory distress syndrome or transient tachypnoea at term requiring admission to the neonatal intensive care unit were recorded prospectively for nine years.
Rosie Maternity Hospital, Cambridge.
During this time 33,289 deliveries occurred at or after 37 weeks of gestation.
This information enabled calculation of the relative risk of respiratory morbidity for respiratory distress syndrome or transient tachypnoea in relation to mode of delivery and onset of parturition for each week of gestation at term.
The incidence of respiratory distress syndrome at term was 2.2/1000 deliveries (95% CI; 1.7-2.7). The incidence of transient tachypnoea was 5.7/1000 deliveries (95% CI; 4.9-6.5). The incidence of respiratory morbidity was significantly higher for the group delivered by caesarean section before the onset of labour (35.5/1000) compared with caesarean section during labour (12.2/1000) (odds ratio, 2.9; 95% CI 1.9-4.4; P < 0.001), and compared with vaginal delivery (5.3/1000) (odds ratio, 6.8; 95% CI 5.2-8.9; P < 0.001). The relative risk of neonatal respiratory morbidity for delivery by caesarean section before the onset of labour during the week 37+0 to 37+6 compared with the week 38+0 to 38+6 was 1.74 (95% CI 1.1-2.8; P < 0.02) and during the week 38+0 to 38+6 compared with the week 39+0 to 39+6 was 2.4 (95% CI 1.2-4.8; P < 0.02).
A significant reduction in neonatal respiratory morbidity would be obtained if elective caesarean section was performed in the week 39+0 to 39+6 of pregnancy.
确定妊娠37至42周之间的分娩时间是否会影响新生儿呼吸结局，从而提供可用于协助足月择期分娩计划的信息。
对前瞻性记录的九年间所有足月时因呼吸窘迫综合征或短暂性呼吸急促而需入住新生儿重症监护病房的病例进行研究。
剑桥罗西妇产医院。
在此期间，妊娠37周及以后共发生33289例分娩。
这些信息能够计算出足月时每周因呼吸窘迫综合征或短暂性呼吸急促导致的呼吸疾病相对风险，与分娩方式和分娩开始时间有关。
足月时呼吸窘迫综合征的发病率为2.2/1000例分娩（95%可信区间；1.7 - 2.7）。短暂性呼吸急促的发病率为5.7/1000例分娩（95%可信区间；4.9 - 6.5）。与产时剖宫产（12.2/1000）相比，临产前剖宫产组（35.5/1000）的呼吸疾病发病率显著更高（优势比，2.9；95%可信区间1.9 - 4.4；P < 0.001），与阴道分娩（5.3/1000）相比也显著更高（优势比，6.8；95%可信区间5.2 - 8.9；P < 0.001）。妊娠37 + 0至37 + 6周临产前剖宫产与38 + 0至38 + 6周相比，新生儿呼吸疾病的相对风险为1.74（95%可信区间1.1 - 2.8；P < 0.02），38 + 0至38 + 6周与39 + 0至39 + 6周相比为2.4（95%可信区间1.2 - 4.8；P < 0.02）。
如果在妊娠39 + 0至39 + 6周进行择期剖宫产，新生儿呼吸疾病发病率将显著降低。
