Divon M Y, Haglund B, Nisell H, Otterblad P O, Westgren M
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
Am J Obstet Gynecol. 1998 Apr;178(4):726-31. doi: 10.1016/s0002-9378(98)70482-x.
Our purpose was to examine the impact of gestational age and fetal growth restriction on fetal and neonatal mortality rates in the postterm pregnancy.
All deliveries occurring in Sweden between Jan. 1, 1987, and Dec. 31, 1992, were evaluated for participation in this study. Data were derived from the National Swedish Medical Birth Registry. Pregnancies were selected for inclusion in the study on the basis of the following criteria: (1) singleton pregnancy, (2) reliable dates, (3) gestational age > or = 40 weeks, and (4) maternal age 15 to 44 years. Fetal growth restriction was defined as birth weight <2 SD below the mean for gestational age. A total of 181,524 pregnancies met the inclusion criteria and formed the study population. Fetal and neonatal mortalities at 40 weeks' gestation were used as reference levels. Logistic regression analysis was used to estimate the independent effects of gestational age and fetal growth restriction on fetal and neonatal mortality rates.
A significant rise in the odds ratio for fetal death was detected from 41 weeks' gestation and on (odds ratios 1.5, 1.8, and 2.9 at 41, 42, and 43 weeks, respectively). Odds ratios for neonatal mortality did not demonstrate a significant gestational age dependency. Fetal growth restriction was associated with significantly higher odds ratios for both fetal and neonatal mortality rates at every gestational age examined (with odds ratios ranging from 7.1 to 10.0 for fetal death and from 3.4 to 9.4 for neonatal death).
Postterm pregnancies have long been considered to be at high risk for adverse perinatal outcome. This study documents a small but significant increase in fetal mortality in accurately dated pregnancies that extend beyond 41 weeks of gestation. This study also demonstrates that fetal growth restriction is independently associated with increased perinatal mortality in these pregnancies.
我们的目的是研究孕周和胎儿生长受限对过期妊娠中胎儿及新生儿死亡率的影响。
对1987年1月1日至1992年12月31日在瑞典发生的所有分娩进行评估，以确定是否参与本研究。数据来源于瑞典国家医疗出生登记处。根据以下标准选择纳入研究的妊娠：（1）单胎妊娠；（2）预产期可靠；（3）孕周≥40周；（4）产妇年龄15至44岁。胎儿生长受限定义为出生体重低于孕周平均体重2个标准差。共有181,524例妊娠符合纳入标准，构成研究人群。将孕40周时的胎儿及新生儿死亡率作为参考水平。采用逻辑回归分析来估计孕周和胎儿生长受限对胎儿及新生儿死亡率的独立影响。
从孕41周及以后，检测到胎儿死亡的比值比显著上升（孕41、42和43周时的比值比分别为1.5、1.8和2.9）。新生儿死亡率的比值比未显示出明显的孕周依赖性。在所检查的每个孕周，胎儿生长受限与胎儿及新生儿死亡率的比值比均显著升高相关（胎儿死亡的比值比范围为7.1至10.0，新生儿死亡的比值比范围为3.4至9.4）。
长期以来，过期妊娠一直被认为围产期不良结局风险高。本研究记录了在准确确定孕周且超过41周的妊娠中，胎儿死亡率虽小幅但显著增加。本研究还表明，胎儿生长受限与这些妊娠中围产期死亡率增加独立相关。
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