目的探讨剖宫产后阴道试产(trail of labor after cesarean,TOLAC)的产程特点,为临床安全管理其产程提供依据。方法回顾性分析2016年1月至2018年12月自然临产的246例足月TOLAC孕妇,以及同时期340例自然临产、阴道分娩足月初产妇(SVB组)...目的探讨剖宫产后阴道试产(trail of labor after cesarean,TOLAC)的产程特点,为临床安全管理其产程提供依据。方法回顾性分析2016年1月至2018年12月自然临产的246例足月TOLAC孕妇,以及同时期340例自然临产、阴道分娩足月初产妇(SVB组)的临床资料。研究TOLAC的产程特点,以及前次剖宫产时机、既往阴道分娩史、妊娠间隔(1.5~3年、>3年)等对TOLAC产程的影响。结果自然临产的足月TOLAC成功率90.2%。伴有阴道分娩史的自然临产的足月TOLAC产妇的第一、第二、总产程时间较无阴道分娩史的自然临产的足月TOLAC(wTOLAC)缩短(P<0.05)。前次妊娠临产前和临产后行剖宫产的两组,以及妊娠间隔处于1.5~3年和>3年的两组的第一、第二、总产程时间均无明显差异。wTOLAC组与SVB组比较,两组的产前体质指数、分娩孕周、产程中干预措施、产后出血量、产后出血率、输血治疗率、妊娠合并症发生率、新生儿1 min Apgar评分、产钳助产率均无明显差异。wTOLAC组的年龄、孕前体质指数、新生儿体重较SVB组大(P<0.05),分娩镇痛率较低(P<0.0001)。应用协方差分析校正上述4个指标的组间差异:两组的产程进展模式类似,第一、总产程时限无明显差异,但第一产程宫口扩张2 cm后,尤其是宫口扩张6 cm后,wTOLAC组产程进展较快(P<0.01);wTOLAC组的第二产程短于SVB组(P<0.001),wTOLAC组内行分娩镇痛的第二产程亦短于SVB组内行分娩镇痛的(P<0.001);wTOLAC组内行分娩镇痛的第二产程和总产程长于未行分娩镇痛者(P<0.05)。结论自然临产的足月TOLAC的产程模式与初产妇类似,宫口扩张6 cm后产程进展较快,且整个产程进展较初产妇稍快,分娩镇痛会延长产程。前次剖宫产时机和妊娠间隔对自然临产的足月TOLAC产程的影响较小,既往阴道分娩史是促进TOLAC产程进展的有利因素。展开更多
Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study ai...Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.展开更多
We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between t...We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between the interpregnancy interval(IPI)and adverse perinatal outcomes. With the 12–23-mon IPI as the reference category, logistic regression analyzes were used to examine associations between different IPIs(<12, 12–23, 24–59, 60–119, and ≥120 mon) and perinatal outcomes(gestational diabetes mellitus, premature membrane rupture, gestational hypertension, preterm birth, low birth weight, and macrosomia).Compared with the 12–23-mon IPI category, women with longer IPIs had a higher risk of adverse perinatal outcomes, and those with an IPI ≥120 mon had the highest risk of gestational diabetes mellitus and premature membrane rupture(adjusted odds ratio(OR) 1.76, 95% confidence interval(CI) 1.32–2.35 and adjusted OR 2.03, 95% CI 1.53–2.67, respectively). These results indicate that a longer IPI is associated with a higher risk of adverse perinatal outcomes and an IPI of ≥120 mon appears to be independently associated with a higher risk of gestational diabetes mellitus and premature membrane rupture.展开更多
Background After the implementation of the universal two-child policy in China,it was more frequent to have long interpregnancy intervals(IPIs)and advanced maternal age.However,the interactions between long IPIs and a...Background After the implementation of the universal two-child policy in China,it was more frequent to have long interpregnancy intervals(IPIs)and advanced maternal age.However,the interactions between long IPIs and advanced maternal age on neonatal outcomes are unknown.Methods The study subjects of this historical cohort study were multiparas with singleton live births between October 1st,2015,and October 31st,2020.IPI was defned as the interval between delivery and conception of the subsequent pregnancy.Logistic regression models were used to calculate adjusted odds ratios(aORs)and 95%confdence intervals(CIs)of the risks of preterm birth(PTB),low birth weight(LBW),small for gestation age,and 1-min Apgar score≤7 in diferent IPI groups.Relative excess risk due to interaction(RERI)was used to evaluate the additive interaction between long IPIs and advanced maternal age.Results Compared with the 24≤IPI≤59 months group,the long IPI group(IPI≥60 months)was associated with a higher risk of PTB(aOR,1.27;95%CI:1.07–1.50),LBW(aOR,1.32;95%CI 1.08–1.61),and one-minute Apgar score≤7(aOR,1.46;95%CI 1.07–1.98).Negative additive interactions(all RERIs<0)existed between long IPIs and advanced maternal age for these neonatal outcomes.Meanwhile,IPI<12 months was also associated with PTB(aOR,1.51;95%CI 1.13–2.01),LBW(aOR,1.50;95%CI 1.09–2.07),and 1-min Apgar score≤7(aOR,1.93;95%CI 1.23–3.04).Conclusions Both short and long IPIs are associated with an increased risk of adverse neonatal outcomes.Appropriate IPI should be recommended to women planning to become pregnant again.In addition,better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.展开更多
Caesarean sections constitute major surgery, and are associated with immediate maternal and perinatal risks with implications on future pregnancies. After a caesarean delivery, the World Health Organization (WHO) reco...Caesarean sections constitute major surgery, and are associated with immediate maternal and perinatal risks with implications on future pregnancies. After a caesarean delivery, the World Health Organization (WHO) recommends an Inter-pregnancy Interval (IPI) of at least 24 months to lower the risk of adverse maternal and perinatal outcomes in the subsequent pregnancy. However, whether the recommendation confers obstetric benefits is unclear as there’s paucity of data in low- and medium-income countries (LMIC). The objective was to determine the association between IPI length and maternal and neonatal outcomes in women with one previous caesarian section undergoing a repeat caesarian delivery at term in Pumwani Maternity Hospital between 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> January 2014 and 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> December 2018. A cross-sectional study was done where patients who had delivered via repeat caesarean section at term between 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> January 2014 and 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> December 2018 were evaluated. The files of 625 patients were retrieved and IPI </span></span><span style="font-family:Verdana;">was </span><span style="font-family:Verdana;">determined from the time interval between a previous caesarean section delivery and the beginning of the subsequent pregnancy, established from the date of the last normal menstrual period as recorded or extrapolated from an early trimester obstetric scan. The files were allotted to study groups as follows: <24 months/short IPI (n</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">170), 24</span><span style="font-family:""> </span><span style="font-family:Ver展开更多
文摘目的探讨剖宫产后阴道试产(trail of labor after cesarean,TOLAC)的产程特点,为临床安全管理其产程提供依据。方法回顾性分析2016年1月至2018年12月自然临产的246例足月TOLAC孕妇,以及同时期340例自然临产、阴道分娩足月初产妇(SVB组)的临床资料。研究TOLAC的产程特点,以及前次剖宫产时机、既往阴道分娩史、妊娠间隔(1.5~3年、>3年)等对TOLAC产程的影响。结果自然临产的足月TOLAC成功率90.2%。伴有阴道分娩史的自然临产的足月TOLAC产妇的第一、第二、总产程时间较无阴道分娩史的自然临产的足月TOLAC(wTOLAC)缩短(P<0.05)。前次妊娠临产前和临产后行剖宫产的两组,以及妊娠间隔处于1.5~3年和>3年的两组的第一、第二、总产程时间均无明显差异。wTOLAC组与SVB组比较,两组的产前体质指数、分娩孕周、产程中干预措施、产后出血量、产后出血率、输血治疗率、妊娠合并症发生率、新生儿1 min Apgar评分、产钳助产率均无明显差异。wTOLAC组的年龄、孕前体质指数、新生儿体重较SVB组大(P<0.05),分娩镇痛率较低(P<0.0001)。应用协方差分析校正上述4个指标的组间差异:两组的产程进展模式类似,第一、总产程时限无明显差异,但第一产程宫口扩张2 cm后,尤其是宫口扩张6 cm后,wTOLAC组产程进展较快(P<0.01);wTOLAC组的第二产程短于SVB组(P<0.001),wTOLAC组内行分娩镇痛的第二产程亦短于SVB组内行分娩镇痛的(P<0.001);wTOLAC组内行分娩镇痛的第二产程和总产程长于未行分娩镇痛者(P<0.05)。结论自然临产的足月TOLAC的产程模式与初产妇类似,宫口扩张6 cm后产程进展较快,且整个产程进展较初产妇稍快,分娩镇痛会延长产程。前次剖宫产时机和妊娠间隔对自然临产的足月TOLAC产程的影响较小,既往阴道分娩史是促进TOLAC产程进展的有利因素。
基金supported by grants from the National Key Research and Development Program of China(Nos.2022YFC2704600,2022YFC2704605,2019YFC1005100)National Health Commission of the People’s Republic of China,the China Medical Board(No.11-065)+1 种基金WHO(No.CHN-12-MCN-004888)UNICEF(No.2016EJH016)
文摘Background:With an increasing proportion of multiparas,proper interpregnancy intervals(IPIs)are urgently needed.However,the association between IPIs and adverse perinatal outcomes has always been debated.This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages.Methods:We used individual data from China’s National Maternal Near Miss Surveillance System between 2014 and 2019.Multivariable Poisson models with restricted cubic splines were used.Each adverse outcome was analyzed separately in the overall model and stratified models.The stratified models included different categories of fertility policy periods(2014-2015,2016-2017,and 2018-2019)and infant gestational age in previous pregnancy(<28 weeks,28-36 weeks,and≥37 weeks).Results:There were 781,731 pregnancies enrolled in this study.A short IPI(≤6 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.63[1.55,1.71]for vaginal delivery[VD]and 1.10[1.03,1.19]for cesarean section[CS]),low Apgar scores and small for gestational age(SGA),and a decreased risk of diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.A long IPI(≥60 months)was associated with an increased risk of preterm birth(OR[95%CI]:1.18[1.11,1.26]for VD and 1.39[1.32,1.47]for CS),placenta previa,postpartum hemorrhage,diabetes mellitus in pregnancy,preeclampsia or eclampsia,and gestational hypertension.Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes.The estimated risk of preterm birth,low Apgar scores,SGA,diabetes mellitus in pregnancy,and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss.Conclusion:For pregnant women with shorter or longer IPIs,more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.
基金the Major Program of National Natural Science Foundation of China (81490742, 31471405, 81771593 and 81671456)the National Key Research and Development Program of China (2017YFC1001303 and 2018YFC1003200)+2 种基金the International Cooperation Project of China and Canada NSFC (81661128010)the Interdisciplinary Key Program of Shanghai Jiao Tong University (YG2014ZD08)the Shen Kang Three-Year Action Plan (16CR3003A)。
文摘We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between the interpregnancy interval(IPI)and adverse perinatal outcomes. With the 12–23-mon IPI as the reference category, logistic regression analyzes were used to examine associations between different IPIs(<12, 12–23, 24–59, 60–119, and ≥120 mon) and perinatal outcomes(gestational diabetes mellitus, premature membrane rupture, gestational hypertension, preterm birth, low birth weight, and macrosomia).Compared with the 12–23-mon IPI category, women with longer IPIs had a higher risk of adverse perinatal outcomes, and those with an IPI ≥120 mon had the highest risk of gestational diabetes mellitus and premature membrane rupture(adjusted odds ratio(OR) 1.76, 95% confidence interval(CI) 1.32–2.35 and adjusted OR 2.03, 95% CI 1.53–2.67, respectively). These results indicate that a longer IPI is associated with a higher risk of adverse perinatal outcomes and an IPI of ≥120 mon appears to be independently associated with a higher risk of gestational diabetes mellitus and premature membrane rupture.
基金Funding for this project was provided by the Sichuan Science and Technology Program,grant No.2019YJ0696 and the Science and Technology Strategic Cooperation Programs of Luzhou Municipal People’s Government and Southwest Medical University,Grant No.2021LZXNYD-J21 to Xiaoping Lei。
文摘Background After the implementation of the universal two-child policy in China,it was more frequent to have long interpregnancy intervals(IPIs)and advanced maternal age.However,the interactions between long IPIs and advanced maternal age on neonatal outcomes are unknown.Methods The study subjects of this historical cohort study were multiparas with singleton live births between October 1st,2015,and October 31st,2020.IPI was defned as the interval between delivery and conception of the subsequent pregnancy.Logistic regression models were used to calculate adjusted odds ratios(aORs)and 95%confdence intervals(CIs)of the risks of preterm birth(PTB),low birth weight(LBW),small for gestation age,and 1-min Apgar score≤7 in diferent IPI groups.Relative excess risk due to interaction(RERI)was used to evaluate the additive interaction between long IPIs and advanced maternal age.Results Compared with the 24≤IPI≤59 months group,the long IPI group(IPI≥60 months)was associated with a higher risk of PTB(aOR,1.27;95%CI:1.07–1.50),LBW(aOR,1.32;95%CI 1.08–1.61),and one-minute Apgar score≤7(aOR,1.46;95%CI 1.07–1.98).Negative additive interactions(all RERIs<0)existed between long IPIs and advanced maternal age for these neonatal outcomes.Meanwhile,IPI<12 months was also associated with PTB(aOR,1.51;95%CI 1.13–2.01),LBW(aOR,1.50;95%CI 1.09–2.07),and 1-min Apgar score≤7(aOR,1.93;95%CI 1.23–3.04).Conclusions Both short and long IPIs are associated with an increased risk of adverse neonatal outcomes.Appropriate IPI should be recommended to women planning to become pregnant again.In addition,better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.
文摘Caesarean sections constitute major surgery, and are associated with immediate maternal and perinatal risks with implications on future pregnancies. After a caesarean delivery, the World Health Organization (WHO) recommends an Inter-pregnancy Interval (IPI) of at least 24 months to lower the risk of adverse maternal and perinatal outcomes in the subsequent pregnancy. However, whether the recommendation confers obstetric benefits is unclear as there’s paucity of data in low- and medium-income countries (LMIC). The objective was to determine the association between IPI length and maternal and neonatal outcomes in women with one previous caesarian section undergoing a repeat caesarian delivery at term in Pumwani Maternity Hospital between 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> January 2014 and 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> December 2018. A cross-sectional study was done where patients who had delivered via repeat caesarean section at term between 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> January 2014 and 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> December 2018 were evaluated. The files of 625 patients were retrieved and IPI </span></span><span style="font-family:Verdana;">was </span><span style="font-family:Verdana;">determined from the time interval between a previous caesarean section delivery and the beginning of the subsequent pregnancy, established from the date of the last normal menstrual period as recorded or extrapolated from an early trimester obstetric scan. The files were allotted to study groups as follows: <24 months/short IPI (n</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">170), 24</span><span style="font-family:""> </span><span style="font-family:Ver
