Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to...Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with展开更多
目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道...目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道分娩孕妇作为VBAC组,34例择期重复剖宫产孕妇作为ERCS组,分析VBAC成功率,比较两组产前及产后12h、48h外周血皮质醇(Cor)、去甲肾上腺素(NE)、T淋巴细胞水平(CD4^+、CD8^+、CD4^+/CD8^+),并比较两组分娩结果。结果 36例孕妇符合VBAC条件,其中26例(72.22%)按计划顺利完成VBAC。两组产后12h、48 h Cor、NE水平较产前降低,差异具有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组产后12h、48h CD4^+、CD4^+/CD8^+水平均较产前降低,CD8^+水平较产前升高,差异具有统计学意义(P<0.05),且VBAC组产后12h、48 h CD4^+、CD4^+/CD8^+水平略高于ERCS组,CD8^+水平略低于ERCS组,差异具有统计学意义(P<0.05);两组新生儿体重及新生儿Apgar评分为8分～10分、产后出血、产褥感染、新生儿窒息、子宫破裂发生几率比较,差异无统计学意义(P>0.05);VBAC组24h出血量、住院费用少于ERCS组,住院时间短于ERCS组,差异具有统计学意义(P<0.05)。结论与ERCS相比,符合VBAC适应证的疤痕子宫再次妊娠孕妇行VBAC,可减轻产后免疫抑制,显著减少术后出血量、住院费用,缩短住院时间,且对新生儿健康、围产期应激反应无明显影响。展开更多
文摘Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with
文摘目的探讨阴道分娩对疤痕子宫再妊娠孕妇围产期应激反应和免疫功能的影响。方法选取2013年5月至2017年5来佛山市南海区第四人民医院孕检并分娩的疤痕子宫再妊娠孕妇60例作为研究对象,根据分娩方式将其分为两组,26例成功剖宫产术后经阴道分娩孕妇作为VBAC组,34例择期重复剖宫产孕妇作为ERCS组,分析VBAC成功率,比较两组产前及产后12h、48h外周血皮质醇(Cor)、去甲肾上腺素(NE)、T淋巴细胞水平(CD4^+、CD8^+、CD4^+/CD8^+),并比较两组分娩结果。结果 36例孕妇符合VBAC条件,其中26例(72.22%)按计划顺利完成VBAC。两组产后12h、48 h Cor、NE水平较产前降低,差异具有统计学意义(P<0.05),但两组间比较差异无统计学意义(P>0.05);两组产后12h、48h CD4^+、CD4^+/CD8^+水平均较产前降低,CD8^+水平较产前升高,差异具有统计学意义(P<0.05),且VBAC组产后12h、48 h CD4^+、CD4^+/CD8^+水平略高于ERCS组,CD8^+水平略低于ERCS组,差异具有统计学意义(P<0.05);两组新生儿体重及新生儿Apgar评分为8分～10分、产后出血、产褥感染、新生儿窒息、子宫破裂发生几率比较,差异无统计学意义(P>0.05);VBAC组24h出血量、住院费用少于ERCS组,住院时间短于ERCS组,差异具有统计学意义(P<0.05)。结论与ERCS相比,符合VBAC适应证的疤痕子宫再次妊娠孕妇行VBAC,可减轻产后免疫抑制,显著减少术后出血量、住院费用,缩短住院时间,且对新生儿健康、围产期应激反应无明显影响。
