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【medical-news】健康孕妇选择剖腹产时机有讲究
Background 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.
Methods 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).
Results 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.
Conclusions Elective repeat cesarean delivery before 39 weeks of gestation is common and is associated with respiratory and other adverse neonatal outcomes.
研究人员早已发现，与剖腹产相比，自然分娩相对更有利于婴儿健康。但出于种种原因，不少健康孕妇依然会选择剖腹产。美国研究人员认为，健康孕妇选择剖腹产最好是怀孕第39周，这一期间出生的婴儿相对在第37周或38周经剖腹产出生的婴儿患各类疾病的风险更小。
美国北卡罗来纳大学等机构的研究人员在最新一期《新英格兰医学杂志》上报告说，他们对13258名孕妇及其婴儿的情况进行了调查研究。这些孕妇健康状况良好，可以自然分娩，但她们中有35.8%的产妇选择在第37周或38周剖腹产，49.1%的产妇选择在第39周剖腹产。这些孕妇此前均有过一次足月的剖腹产。通常情况下，孕期为40周左右，但一般在37周时胎儿就已足月。
研究发现，在第37周或38周经剖腹产出生的婴儿出现健康问题的几率是在第39周经剖腹产出生婴儿的两倍，例如呼吸问题、感染、低血糖或需要进行重病特别护理等。而且，前者出现并发症的比例也明显高于后者。
据悉，目前在美国越来越多的孕妇选择剖腹产，但专家认为，自然分娩过程更有利于婴儿的健康，因此并不鼓励孕妇在无医学必要的情况下选择剖腹产。
（《新英格兰医学杂志》（NEJM），Volume 360:111-120，Alan T.N. Tita，Brian M. Mercer） 谢谢，学习了！ [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-09-01 05:11
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