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AJOG：围存活期臀位不同分娩方式结局

2015-03-13 MedSci译 MedSci原创

围存活期臀位剖宫产
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近期Tucker Edmonds B等人进行了一项回顾性研究，评估23-24+6周孕（围存活期）臀位不同分娩方式（剖宫产vs.阴道分娩）新生儿的发病率和死亡率。该研究共纳入加利福尼亚、密苏里州和宾夕法尼亚州2000-2009年间1854名研究对象，按孕周对其进行分层（23-23+6周孕 vs. 24-24+6周孕）。

研究结果显示，23-23+6周孕有46%（335名）为剖宫产，24-24+6周孕有77%（856）为剖宫产；经过多因素分析得出，剖宫产较顺产，新生儿整体生存率更高：A OR=3.98 95% CI=2.24, 7.06; 阴道分娩：AOR=2.91, 95% CI=1.76, 4.81。无急诊指征剖宫产出的新生在主要病因（IVH、BPD、NEC、窒息）有超过两倍的发生率：23-23+6周孕AOR=2.83, 95% CI=1.37, 5.84; 24-24+6周孕AOR=2.07, 95% CI=1.11,3.86。对于插管的新生儿，剖宫产可以改善短期生存率，但是超过6个月（校正胎龄）的生存率与顺产的无差异：AOR=1.77, 95% CI=0.83, 3.74; AOR=1.50, 95% CI=0.81,2.76。对于23-23+6周孕无急诊指征、体重＜500g的插管，剖宫产和顺产对生存率无差异。

研究结果表明，剖宫产增加了围存活期臀位新生儿的整体生存率和主要病因的发病率。在插管新生儿中，剖宫产改善了短期生存率，但是在第6个月生存率，与顺产无差异。剖宫产不能改善体重＜500g的新生儿生存率。

原始出处：
Tucker Edmonds B, Mckenzie F, Macheras M, Srinivas SK, Lorch SA.Morbidity and mortality associated with mode of delivery for breech periviable deliveries. Am J Obstet Gynecol. 2015 Mar 3. pii: S0002-9378(15)00196-9.

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    2015-12-07 stfoxst

    #分娩方式#

    0

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    2015-03-15 linlin2312

    #分娩#

    0

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    2015-03-15 hukaixun

    #存活期#

    0

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    2015-03-14 zhouanxiu

    medsic资源丰富

    0

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    2015-03-14 zhouanxiu

    医学太奥妙了

    0