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NEJM：颠覆！提前催产优于足月顺产？

2018-08-21 MedSci MedSci原创

催产足月顺产
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我们都知道，剖宫产作为产科干预的最终手段，有其绝对的适应症，不到紧急情况决不能轻易使出。剖宫产也不像大众想象的那么简单，是手术定有其并发症。并且在二胎开放的今天，瘢痕子宫无疑是产科医生和家庭均要面对的重要挑战。 如何在降低剖宫产率的同时，确保产妇和宝宝的安全？这是无数产科医生多年来探究的问题。 若女性平素周期规律，以末次月经的第一日算起，正常妊娠时长一般在37~42周。28~3

我们都知道，剖宫产作为产科干预的最终手段，有其绝对的适应症，不到紧急情况决不能轻易使出。剖宫产也不像大众想象的那么简单，是手术定有其并发症。并且在二胎开放的今天，瘢痕子宫无疑是产科医生和家庭均要面对的重要挑战。 如何在降低剖宫产率的同时，确保产妇和宝宝的安全？这是无数产科医生多年来探究的问题。 若女性平素周期规律，以末次月经的第一日算起，正常妊娠时长一般在37~42周。28~37周内出生的为早产儿，而大于42周即称为过期妊娠。 过期妊娠在剖宫产因素中占到了很大的比重。在过去的很长一段时间，产科医生把41周作为绝对干预的指征。我们可以设想，假如把其指征提前到40周甚至39周，在胎儿与母体更加安全的时间内，提前干预处理，能否有效降低并发症的发生剖宫产率与并发症的发生呢？ 美国西北大学的医学博士William A. Grobman等人的最新研究于上周在New England Journal of Medicine(NEJM)上发表，该研究表示：怀孕39周时催产可显著降低剖腹产需求，其它指标也明显改善。此前报道：NEJM：低风险未经产妇引产与待产比较 颠覆性的结论 在此项研究之前，有大量研究表

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  1. 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26 19:44:22 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340810, encodeId=45e43408108f, content=可以做一个rct看看，有前景啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Sun Aug 26 02:29:01 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340534, encodeId=f1f9340534da, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, 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    2018-08-27 哈哈869

    学习了

    0

  2. 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level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-26 哈哈869

    学习了

    0

  3. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-26 Dr.jerry

    可以做一个rct看看，有前景啊

    0

  4. 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26 19:44:22 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340810, encodeId=45e43408108f, content=可以做一个rct看看，有前景啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Sun Aug 26 02:29:01 CST 2018, time=2018-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340534, encodeId=f1f9340534da, content=学了, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-24 哈哈869

    学了

    0

  5. 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level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-23 zhanfl

    #催产#

    0

  6. 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level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-23 couragewjy

    如果是这样，减少剖宫产挺好的

    0

  7. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-23 15938038573红旗飘飘

    已学习

    0

  8. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-22 邓启付

    提前引产明显降低母婴风险，值得提倡。

    0

  9. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-22 Arthur M

    这样的研究在国内应该是无法完成的，伦理风险太大了

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Wed Aug 22 17:15:37 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340168, encodeId=2aff3401687c, content=这样的研究在国内应该是无法完成的，伦理风险太大了, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLB2lWFzjaQjxC33RfYGdWpDovtkkdhzWmm9c4lRfGccXhIurkRaLuS5VBHDGBbAOTm2bWazV6x9wg/0, createdBy=342e1692193, createdName=Arthur M, createdTime=Wed Aug 22 15:24:20 CST 2018, time=2018-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340138, encodeId=b8c7340138a7, content=毁三观, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/30/dd6bade062cb598667f9f577194196c4.jpg, createdBy=422e1687020, createdName=Dr.jerry, createdTime=Wed Aug 22 12:23:19 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-22 Dr.jerry

    毁三观

    0

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