摘要
目的 比较不同孕周行足月择期剖宫产的新生儿结局.方法 自2002年9月至2009年11月根据北京协和医院产科电子数据库系统登记的所有中国人群的孕产妇资料中,选择妊娠满37周后在临产前没有明确妇产科和内科合并症的宫内单胎活产儿的孕妇施行择期剖宫产的病历资料,采用单因素方差分析母亲的一般情况,采用趋势检验方法比较不同孕周组的新生儿不良事件的发生情况,包括新生儿死亡、呼吸系统疾病（呼吸窘迫综合征或短暂的窒息）、感染（包括败血症）、转入新生儿重症监护病房、在新生儿重症监护病房住院＞5 d等.结果 共4565例初次和409例再次足月择期剖宫产病例纳入分析.妊娠39周前行手术者和妊娠39～39＋6周中初次剖宫产者占所有足月初次择期剖宫产总数的比例分别为48.1%（2194/4565）和40.0%（1828/4565）.再次择期剖宫产者中妊娠39周前和妊娠39～39＋6周手术者的比例分别为67.2%（275/409）和29.3%（120/409）.未发生围产期胎儿或新生儿死亡.与妊娠39～39＋6周相比,妊娠37～37＋6周和38～38＋6周行择期剖宫产均可能增加新生儿不良事件的发生风险：初次剖宫产,妊娠37～37＋6周OR=1.4（95% CI：0.9～2.0）,38～38＋6周OR=1.1（95%CI：0.9～1.4）;再次剖宫产,37～37＋6周OR=2.5（95% CI：1.1～5.8）,38～38＋6周OR=1.3（95%CI：0.6～2.7）.结论 我院妊娠39周前的择期剖宫产比例较高,但可能增加新生儿呼吸系统疾病等不良事件的发生风险.建议将妊娠39～39＋6周作为择期剖宫产的时机以减少新生儿呼吸系统等不良时间的发生风险.
Objective To compare the neonatal outcomes of different gestational age at which elective cesarean sections at term were performed. Methods All the cases of cesarean section registered in Peking Union Medical College Hospital from September 2002 to November 2009 were collected. Women with viable singleton pregnancies delivered before the onset of labor and without recognized indications for cesarean section after 37 weeks at term were included and their general information and outcomes were compared with one-way ANOVA. All the maternal data and neonatal adverse events were compared with Cochran-Armitage test among different gestational weeks, including respiratory complications （respiratory distress syndrome or transient tachypnea of the newborn）, infections, admission to the neonatal intensive care unit （NICU）, and hospitalization in NICU〉5 d. Results Of 8122 primary cesarean sections and 594 repeat cesarean sections at term, 4565 and 409 cases were performed electively as the primary or repeat cesarean section. Among the 4565 women underwent primary elective cesarean sections, 2194 （48.1%） were before 39 gestational weeks,and 1828 （40.0%） at 39-39＋6 weeks. While, among the 409 repeat elective cesareans sections, these figures were 275 （67.2%） and 120 （29.3%）, respectively. No fetal or neonatal death occurred during perinatal period. Compared with births at 39-39＋6 weeks, births at 37-37＋6 weeks or 38-38＋6 weeks were associated with increased risk of the neonatal adverse events. For the primary cesarean section cases, the odds ratio （OR） for births at 37-37＋6 weeks and 38-38＋6 weeks was 1.4 （95% CI： 0.9-2.0） and 1.1 （95% CI： 0.9-1.4）, respectively. For the repeat cesarean section cases, OR for births at 37-37＋6 weeks and 38-38＋6 weeks was 2.5 （95% CI： 1.1-5.8） and 1.3 （95% CI： 0.6-2.7） respectively. Conclusions Elective cesarean section before 39 weeks of gestation is popular and associated with adverse neonatal outcomes. Elective cesarean section performed after 39-39＋6 gestational weeks might decrease the risk of adverse neonatal outcomes.
出处
《中华围产医学杂志》
CAS
2011年第1期12-18,共7页
Chinese Journal of Perinatal Medicine
关键词
剖宫产术
婴儿
新生
呼吸道疾病
外科手术
选择性
Cesarean section Infant,newborn Respiratory tract diseases Surgical procedure,elective
