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41周催产可降低围产儿死亡率
作者:小柯机器人 发布时间:2019/11/24 14:06:31

瑞典哥德堡萨尔格伦斯卡大学医院Ulla-Britt Wennerholm小组的一项最新研究比较了41周催产与预期管理和42周催产的围产儿结局。相关论文于2019年11月20日发表在《英国医学杂志》上。

2016-2018年,研究组在瑞典的14家医院进行了一项多中心、开放标签、随机、优势试验,招募了2760名低危单胎妊娠妇女,在瑞典妊娠登记处按1:1随机分组,1381名接受41周催产(催产组),1379名接受预期管理和42周催产(预期管理组)。综合围产期结局包括死产、新生儿死亡、5分钟Apgar评分小于7分、pH<7或代谢性酸中毒。

由于预期管理组的围产儿死亡率明显高于催产组,研究提前终止。催产组和预期管理组的围产期综合结局发生率分别为2.4%和2.2%,差异无统计学意义。催产组未发生围产儿死亡,预期管理组中发生6例,其中5例死产,1例早期新生儿死亡,组间差异显著。两组间剖腹产、器械阴道分娩或全因产妇发病率均无显著差异。

总之,与42周预期管理相比,41周催产显著降低了围产儿的死亡率。研究组建议孕妇应在41周前分娩,以降低死产率。

附:英文原文

Title: Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial

Author: Ulla-Britt Wennerholm, Sissel Saltvedt, Anna Wessberg, Mrten Alkmark, Christina Bergh, Sophia Brismar Wendel, Helena Fadl, Maria Jonsson, Lars Ladfors, Verena Sengpiel, Jan Wesstrm, Gran Wennergren, Anna-Karin Wikstrm, Helen Elden, Olof Stephansson, Henrik Hagberg

Issue&Volume: 2019/11/20

Abstract:

Objective To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks.

Design Multicentre, open label, randomised controlled superiority trial.

Setting 14 hospitals in Sweden, 2016-18.

Participants 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group.

Interventions Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks.

Main outcome measures The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat.

Results The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups.

Conclusions This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths.

DOI: 10.1136/bmj.l6131

Source: https://www.bmj.com/content/367/bmj.l6131

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj