剖宫产术,再%妊娠结局
剖宮產術,再%妊娠結跼
부궁산술,재%임신결국
Cesarean section,repeat%Pregnancy outcome
目的 分析不同孕周行择期再次剖宫产的母儿围产期结局,探讨再次剖宫产的最佳终止妊娠时机. 方法 回顾性收集重庆医科大学附属第一医院(简称本院)产科电子病历系统记录的自2011年6月1日至2013年6月30日住院分娩的所有产妇资料.选择妊娠满37周且无合并症的单胎、行择期再次剖宫产的产妇为研究对象,根据孕周不同进行分组.采用单因素方差分析或x2检验,比较不同孕周终止妊娠的孕产妇的一般情况和妊娠结局以及新生儿不良事件的发生情况. 结果 共579例足月行再次剖宫产的产妇纳入本研究,其中妊娠39周前手术与39～周手术的比例分别为64.6％(374/579,其中37～周分娩者93例,38～周分娩者281例)和29.0％(168/579),无孕产妇、胎儿或新生儿死亡.妊娠37～周、38～周、39～周、40～周和≥41周分娩的产妇2次剖宫产间隔时间差异无统计学意义(P＞0.05),住院时间差异有统计学意义[分别为(4.9±3.0)、(4.3±1.3)、(4.3±1.0)、(4.5±1.2)和(4.0±0.7)d,F=2.849,P＜0.05].不同孕周分娩的产妇终止妊娠时体重指数、胎盘胎膜残留、术中术后出血、胎膜早破、转重症监护病房和子宫切除等情况差异均无统计学意义(P值均＞0.05).5组分娩新生儿的出生体重和出生身长差异均有统计学意义[体重:(3 082.9±479.2)、(3 318.1±390.8)、(3 415.7±431.1)、(3 630.5±475.2)和(3 334.0±242.5)g,F=13.798;身长:(48.8±1.5)、(49.3±1.5)、(49.6±1.5)、(50.0±1.5)和(47.8±3.9)cm,F=7.460;P值均＜0.05],1 min和5 minApgar评分差异亦有统计学意义[1 min:(9.7±0.7)、(9.8±0.6)、(9.8±0.4)、(9.7±0.5)和(8.8±2.7)分,F=4.432;5 min:(9.9±0.3)、(10.0±0.3)、(10.0±0.2)、(10.0±0.2)和(9.2±1.8)分,F=9.625;P值均＜0.05].5组新生儿不良事件发生率包括转新生儿重症监护病房(neonatal intensive care unit,NICU)、接受心肺复苏或呼吸机治疗、窒息和住NICU≥5d的比例差异有统计学意义[总体:5.4％(5/93)、1.8％(5/281)、0.6％(1/168)、0.0％ (0/32)和2/5,x2=16.812;转NICU:3.2％ (3/93)、1.1％ (3/281)、0.0％(0/168)、0.0％(0/32)和1/5;x2=11.294;接受心肺复苏或呼吸机治疗:2.2％ (2/93)、0.7％ (2/281)、0.0％(0/168)、0.0％(0/32)和1/5,x2=10.584;窒息:1.1％(1/93)、0.7％(2/281)、0.0％(0/168)、0.0％(0/32),x2=9.637; 住NICU≥5 d:3.2％ (3/93)、1.1％ (3/281)、0.0％(0/168)、0.0％(0/32) 和1/5,x2=11.294;P值均＜0.05].以妊娠39～周终止妊娠为标准,妊娠37～周、38～周行再次剖宫产所分娩的新生儿不良事件的发生风险(OR值及其95％CI)分别为1.1(1.0～2.1)和1.3(0.9～1.9).结论 本院妊娠39周前行择期再次剖宫产比例较高,提前终止妊娠并未降低产妇不良妊娠结局的发生率,但却增加新生儿不良事件的发生风险.因此,在兼顾母体安全的前提下,为减少围产儿不良事件的发生率,建议将妊娠39～39+6周作为择期再次剖宫产的最佳时机.
目的 分析不同孕週行擇期再次剖宮產的母兒圍產期結跼,探討再次剖宮產的最佳終止妊娠時機. 方法 迴顧性收集重慶醫科大學附屬第一醫院(簡稱本院)產科電子病歷繫統記錄的自2011年6月1日至2013年6月30日住院分娩的所有產婦資料.選擇妊娠滿37週且無閤併癥的單胎、行擇期再次剖宮產的產婦為研究對象,根據孕週不同進行分組.採用單因素方差分析或x2檢驗,比較不同孕週終止妊娠的孕產婦的一般情況和妊娠結跼以及新生兒不良事件的髮生情況. 結果 共579例足月行再次剖宮產的產婦納入本研究,其中妊娠39週前手術與39～週手術的比例分彆為64.6％(374/579,其中37～週分娩者93例,38～週分娩者281例)和29.0％(168/579),無孕產婦、胎兒或新生兒死亡.妊娠37～週、38～週、39～週、40～週和≥41週分娩的產婦2次剖宮產間隔時間差異無統計學意義(P＞0.05),住院時間差異有統計學意義[分彆為(4.9±3.0)、(4.3±1.3)、(4.3±1.0)、(4.5±1.2)和(4.0±0.7)d,F=2.849,P＜0.05].不同孕週分娩的產婦終止妊娠時體重指數、胎盤胎膜殘留、術中術後齣血、胎膜早破、轉重癥鑑護病房和子宮切除等情況差異均無統計學意義(P值均＞0.05).5組分娩新生兒的齣生體重和齣生身長差異均有統計學意義[體重:(3 082.9±479.2)、(3 318.1±390.8)、(3 415.7±431.1)、(3 630.5±475.2)和(3 334.0±242.5)g,F=13.798;身長:(48.8±1.5)、(49.3±1.5)、(49.6±1.5)、(50.0±1.5)和(47.8±3.9)cm,F=7.460;P值均＜0.05],1 min和5 minApgar評分差異亦有統計學意義[1 min:(9.7±0.7)、(9.8±0.6)、(9.8±0.4)、(9.7±0.5)和(8.8±2.7)分,F=4.432;5 min:(9.9±0.3)、(10.0±0.3)、(10.0±0.2)、(10.0±0.2)和(9.2±1.8)分,F=9.625;P值均＜0.05].5組新生兒不良事件髮生率包括轉新生兒重癥鑑護病房(neonatal intensive care unit,NICU)、接受心肺複囌或呼吸機治療、窒息和住NICU≥5d的比例差異有統計學意義[總體:5.4％(5/93)、1.8％(5/281)、0.6％(1/168)、0.0％ (0/32)和2/5,x2=16.812;轉NICU:3.2％ (3/93)、1.1％ (3/281)、0.0％(0/168)、0.0％(0/32)和1/5;x2=11.294;接受心肺複囌或呼吸機治療:2.2％ (2/93)、0.7％ (2/281)、0.0％(0/168)、0.0％(0/32)和1/5,x2=10.584;窒息:1.1％(1/93)、0.7％(2/281)、0.0％(0/168)、0.0％(0/32),x2=9.637; 住NICU≥5 d:3.2％ (3/93)、1.1％ (3/281)、0.0％(0/168)、0.0％(0/32) 和1/5,x2=11.294;P值均＜0.05].以妊娠39～週終止妊娠為標準,妊娠37～週、38～週行再次剖宮產所分娩的新生兒不良事件的髮生風險(OR值及其95％CI)分彆為1.1(1.0～2.1)和1.3(0.9～1.9).結論 本院妊娠39週前行擇期再次剖宮產比例較高,提前終止妊娠併未降低產婦不良妊娠結跼的髮生率,但卻增加新生兒不良事件的髮生風險.因此,在兼顧母體安全的前提下,為減少圍產兒不良事件的髮生率,建議將妊娠39～39+6週作為擇期再次剖宮產的最佳時機.
목적 분석불동잉주행택기재차부궁산적모인위산기결국,탐토재차부궁산적최가종지임신시궤. 방법 회고성수집중경의과대학부속제일의원(간칭본원)산과전자병력계통기록적자2011년6월1일지2013년6월30일주원분면적소유산부자료.선택임신만37주차무합병증적단태、행택기재차부궁산적산부위연구대상,근거잉주불동진행분조.채용단인소방차분석혹x2검험,비교불동잉주종지임신적잉산부적일반정황화임신결국이급신생인불량사건적발생정황. 결과 공579례족월행재차부궁산적산부납입본연구,기중임신39주전수술여39～주수술적비례분별위64.6％(374/579,기중37～주분면자93례,38～주분면자281례)화29.0％(168/579),무잉산부、태인혹신생인사망.임신37～주、38～주、39～주、40～주화≥41주분면적산부2차부궁산간격시간차이무통계학의의(P＞0.05),주원시간차이유통계학의의[분별위(4.9±3.0)、(4.3±1.3)、(4.3±1.0)、(4.5±1.2)화(4.0±0.7)d,F=2.849,P＜0.05].불동잉주분면적산부종지임신시체중지수、태반태막잔류、술중술후출혈、태막조파、전중증감호병방화자궁절제등정황차이균무통계학의의(P치균＞0.05).5조분면신생인적출생체중화출생신장차이균유통계학의의[체중:(3 082.9±479.2)、(3 318.1±390.8)、(3 415.7±431.1)、(3 630.5±475.2)화(3 334.0±242.5)g,F=13.798;신장:(48.8±1.5)、(49.3±1.5)、(49.6±1.5)、(50.0±1.5)화(47.8±3.9)cm,F=7.460;P치균＜0.05],1 min화5 minApgar평분차이역유통계학의의[1 min:(9.7±0.7)、(9.8±0.6)、(9.8±0.4)、(9.7±0.5)화(8.8±2.7)분,F=4.432;5 min:(9.9±0.3)、(10.0±0.3)、(10.0±0.2)、(10.0±0.2)화(9.2±1.8)분,F=9.625;P치균＜0.05].5조신생인불량사건발생솔포괄전신생인중증감호병방(neonatal intensive care unit,NICU)、접수심폐복소혹호흡궤치료、질식화주NICU≥5d적비례차이유통계학의의[총체:5.4％(5/93)、1.8％(5/281)、0.6％(1/168)、0.0％ (0/32)화2/5,x2=16.812;전NICU:3.2％ (3/93)、1.1％ (3/281)、0.0％(0/168)、0.0％(0/32)화1/5;x2=11.294;접수심폐복소혹호흡궤치료:2.2％ (2/93)、0.7％ (2/281)、0.0％(0/168)、0.0％(0/32)화1/5,x2=10.584;질식:1.1％(1/93)、0.7％(2/281)、0.0％(0/168)、0.0％(0/32),x2=9.637; 주NICU≥5 d:3.2％ (3/93)、1.1％ (3/281)、0.0％(0/168)、0.0％(0/32) 화1/5,x2=11.294;P치균＜0.05].이임신39～주종지임신위표준,임신37～주、38～주행재차부궁산소분면적신생인불량사건적발생풍험(OR치급기95％CI)분별위1.1(1.0～2.1)화1.3(0.9～1.9).결론 본원임신39주전행택기재차부궁산비례교고,제전종지임신병미강저산부불량임신결국적발생솔,단각증가신생인불량사건적발생풍험.인차,재겸고모체안전적전제하,위감소위산인불량사건적발생솔,건의장임신39～39+6주작위택기재차부궁산적최가시궤.
Objective To explore the optimal timing of termination of pregnancy,we analyzed the different gestational age in repeat cesarean delivery and maternal and neonatal outcomes.Methods This was a retrospective study.The information of cesarean sections was collected from maternal obstetric records in the electronic medical recording system of the First Affiliated Hospital of Chongqing Medical University from June 1,2011 to June 30,2013,and women with intrauterine viable singleton pregnancies delivered after 37 weeks of gestation without prenatal complications were selected.They were divided into five groups with different gestational weeks.Maternal general information,perioperative outcome and rate of neonatal adverse event were analyzed with one way ANOVA analysis and Chi-square test.Results A total of 579 cases of elective repeat cesarean at term were performed.The ratios of cesarean section prior to 39 and 39-39+6 weeks of gestation were 64.6％ (374/579) and 29.0％ (168/579),respectively.No fetal,neonatal or maternal death occurred.There were no statistically significant differences in the termination of pregnancy at 37-37+6 weeks,38 38+6 weeks,39-39+6 weeks,40 weeks and ≥ 41 weeks between the two time intervals for cesarean section (P＞0.05).There were statistically significant differences in the length of hospitalization [(4.9±3.0),(4.3 ± 1.3),(4.3 ± 1.0),(4.5± 1.2) and (4.0±0.7) d,respectively; F=2.849,P＜0.05].No significant difference was observed in the maternal BMI,placental membrane residue,maternal perioperative bleeding,premature rupture of membrane (PROM),intensive care unit (ICU) admission and uterine resection (P＞0.05).There were statistically significant differences among the five groups in neonatal weight [(3 082.9±479.2),(3 318.1 ±390.8),(3 415.7±431.1),(3 630.5±475.2) and (3 334.0±242.5) g,F=13.798] and length [(48.8± 1.5),(49.3± 1.5),(49.6± 1.5),(50.0± 1.5) and (47.8±3.9) cm,F=7.460; both P＜0.05].One min and 5 min Apgar scores also showed statistically significant differences [1 min:(9.7±0.7),(9.8±0.6),(9.8±0.4),(9.7±0.5) and (8.8±2.7) ; F=4.432; 5 min:(9.9±0.3),(10.0±0.3),(10.0±0.2),(10.0±0.2) and (9.2± 1.8),F=9.625; all P＜0.05].The overall rates of neonatal adverse events,including the admission to neonatal intensive care units (NICU),the rates of cardiopulmonary resuscitation or ventilator therapy,asphyxiation,as well as the length of stay in NICU ≥ 5 d among the five groups also showed statistically significant differences [overall:5.4％ (5/93),1.8％ (5/281),0.6％ (1/168),0.0％ (0/32) and 2/5,x2=16.812;NICU:3.2％ (3/93),1.1％ (3/281),0.0％ (0/168),0.0％ (0/32) and 1/5; x2=1 1.294; cardiopulmonary resuscitation or ventilator therapy:2.2％ (2/93),0.7％ (2/281),0.0％ (0/168),0.0％(0/32) and 1/5,x2=10.584; asphyxiation:1.1％ (1/93),0.7％ (2/281),0.0％ (0/168),0.0％ (0/32) and 1/5,x2=9.637; NICU ≥ 5 d:3.2％ (3/93),1.1％ (3/281),0.0％ (0/168),0.0％ (0/32) and 1/5,x2=1 1.294; P＜0.05].The risks of neonatal adverse outcomes in delivery at 37-38+6 weeks were:OR=1.1(95％CI:1.0-2.1) at 37 37+6 weeks,OR=1.3 (95％CI:0.9-1.9) at 38-38+6 weeks,compared with delivery at 39-39+6 weeks.Conclnsions The percentage of repeat cesarean delivery prior to 39 weeks of gestation is high in our hospital,early termination of pregnancy would not reduce the maternal perioperative adverse outcome,but may increase the risk of neonatal adverse events.Taking into account the maternal benefit,we suggest 39 39+6 weeks of gestation as the best time of elective repeat cesarean in order to reduce the risk of neonatal adverse events.
