Interpregnancy Interval and Obstetrical Complications
Interpregnancy Interval and Obstetrical Complications
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DOI：
10.1097/ogx.0b013e31826b2c3e
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发表时间：
2012-09-01
影响因子：
6.2
通讯作者：
Lyell, Deirdre J.
中科院分区：
文献类型：
--
作者：
Shachar, Bat Zion;Lyell, Deirdre J.
产科医生经常提出关于最佳解释间隔（IPI）的问题。短IPI与不良围产期和孕产妇结局相关，从早产和低出生体重到新生儿和孕产妇发病率和死亡率。长期IPI反过来与先兆子痫和难产的风险增加有关。在这篇综述中，我们讨论了这些协会的数据沿着最近的研究揭示协会短IPI与出生缺陷，精神分裂症和自闭症。最佳IPI可能因不同的亚组而异。我们讨论了短期IPI对剖宫产妇女的影响，特别是子宫破裂的风险增加和对该亚组进行分娩试验的考虑。我们回顾研究检查短IPI和先进的产妇年龄之间的相互作用，并讨论这些妇女的风险效益评估。最后，我们把注意力转向死胎或堕胎后的妇女，她们往往希望在最短的时间内再次怀孕。我们讨论的研究有利于在这一组较短的IPI。积累的数据使人们能够重新评价新闻学会目前针对一般妇女和有特殊情况的次群体的建议和管理准则。特别是，我们建议将目前的最低IPI建议降低到18个月（根据世界卫生组织的最新建议为24个月），对于高龄妇女和自然流产或人工流产后怀孕的妇女，建议的最低IPI甚至更短。
Obstetricians are often presented with questions regarding the optimal interpregnancy interval (IPI). Short IPI has been associated with adverse perinatal and maternal outcomes, ranging from preterm birth and low birth weight to neonatal and maternal morbidity and mortality. Long IPI has in turn been associated with increased risk for preeclampsia and labor dystocia. In this review, we discuss the data regarding these associations along with recent studies revealing associations of short IPI with birth defects, schizophrenia, and autism. The optimal IPI may vary for different subgroups. We discuss the consequences of short IPI in women with a prior cesarean section, in particular the increased risk for uterine rupture and the considerations regarding a trial of labor in this subgroup. We review studies examining the interaction between short IPI and advanced maternal age and discuss the risk-benefit assessment for these women. Finally, we turn our attention to women after a stillbirth or an abortion, who often desire to conceive again with minimal delay. We discuss studies speaking in favor of a shorter IPI in this group. The accumulated data allow for the reevaluation of current IPI recommendations and management guidelines for women in general and among subpopulations with special circumstances. In particular, we suggest lowering the current minimal IPI recommendation to only 18 months (vs 24 months according to the latest World Health Organization recommendations), with even shorter recommended minimal IPI for women of advanced age and those who conceive after a spontaneous or induced abortion.