Timing of elective repeat cesarean delivery at term and neonatal outcomes.
Timing of elective repeat cesarean delivery at term and neonatal outcomes.
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DOI：
10.1056/nejmoa0803267
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发表时间：
2009-01-08
期刊：
影响因子：
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通讯作者：
Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network
中科院分区：
文献类型：
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作者：
Tita AT;Landon MB;Spong CY;Lai Y;Leveno KJ;Varner MW;Moawad AH;Caritis SN;Meis PJ;Wapner RJ;Sorokin Y;Miodovnik M;Carpenter M;Peaceman AM;O'Sullivan MJ;Sibai BM;Langer O;Thorp JM;Ramin SM;Mercer BM;Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network
由于呼吸系统并发症的发生率增加，除非有胎儿肺成熟的证据，否则不鼓励在妊娠39周前进行选择性剖宫产。我们评估了足月（孕37周或更长）但孕39周前选择性剖宫产与新生儿结局之间的关系。我们研究了1999年至2002年在尤尼斯肯尼迪施莱佛国家儿童健康和人类发展研究所母胎医学单位网络的19个中心进行重复剖宫产的连续患者队列。有生育能力的单胎妊娠妇女选择性分娩（即，分娩开始前和妊娠39周前没有任何公认的分娩指征）。主要结局是新生儿死亡和任何几种不良事件的复合，包括呼吸系统并发症、经治疗的低血糖、新生儿败血症和入住新生儿重症监护室（ICU）。在24，077例足月重复剖宫产分娩中，13，258例选择性进行;其中35.8%在妊娠39周前进行（6.3%在37周，29.5%在38周），49.1%在妊娠39周。1例新生儿死亡。与39周出生相比，37周和38周出生与主要结局风险增加相关（37周出生的校正比值比为2.1; 95%置信区间[CI]为1.7至2.5; 38周出生的校正比值比为1.5; 95% CI为1.3至1.7;趋势P <0.001）。不良呼吸结局、机械通气、新生儿败血症、低血糖、新生儿ICU入院和住院5天或以上的发生率在37周出生时增加了1.8至4.2倍，在38周出生时增加了1.3至2.1倍。妊娠39周前选择性重复剖宫产是常见的，与呼吸和其他不良新生儿结局相关。
Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes. We studied a cohort of consecutive patients undergoing repeat cesarean sections performed at 19 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network from 1999 through 2002. Women with viable singleton pregnancies delivered electively (i.e., before the onset of labor and without any recognized indications for delivery before 39 weeks of gestation) were included. The primary outcome was the composite of neonatal death and any of several adverse events, including respiratory complications, treated hypoglycemia, newborn sepsis, and admission to the neonatal intensive care unit (ICU). Of 24,077 repeat cesarean deliveries at term, 13,258 were performed electively; of these, 35.8% were performed before 39 completed weeks of gestation (6.3% at 37 weeks and 29.5% at 38 weeks) and 49.1% at 39 weeks of gestation. One neonatal death occurred. As compared with births at 39 weeks, births at 37 weeks and at 38 weeks were associated with an increased risk of the primary outcome (adjusted odds ratio for births at 37 weeks, 2.1; 95% confidence interval [CI], 1.7 to 2.5; adjusted odds ratio for births at 38 weeks, 1.5; 95% CI, 1.3 to 1.7; P for trend <0.001). The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks. Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes.