先天分心臟病胎兒推延臨產(chǎn)獲益有限

    悉尼--依據(jù)國際婦產(chǎn)科超聲學(xué)會（ISUOG）國際大會上發(fā)布的一項研討，關(guān)于患有嚴(yán)峻先天分心臟病的胎兒，從擇期晚期早產(chǎn)轉(zhuǎn)變至前期臨產(chǎn)對重癥監(jiān)護時刻、新生兒患病率或死亡率等新生兒結(jié)局影響甚微。

    2009年宣布的一項研討標(biāo)明，39周后臨產(chǎn)的嬰幼兒結(jié)局有所改善，爾后根據(jù)這一成果，產(chǎn)科臨產(chǎn)實習(xí)發(fā)生了革新。為了評估這種實習(xí)做法上的革新所形成的影響，哥倫比亞大學(xué)醫(yī)學(xué)中間及摩根斯坦利兒童醫(yī)院的研討者們進行了本研討。他們對危重先天分心臟病患兒的病歷進行了檢查，并將878名于2004--2008年間在一家三級醫(yī)療中間出世的嬰幼兒的結(jié)局與124名在2010年（即施行革新之后）出世的嬰幼兒進行對比。

    成果顯現(xiàn)，后一組嬰兒出世時的均勻胎齡（分別為37.8周vs. 38.4周；P<0.01）及均勻體重（2,975 g vs. 3,134 g;P<0.01）顯著添加，但在5分鐘APGAR評分（8.5vs.8.6;P=0.11）、中位住院天數(shù)（14天[1--197] vs. 16 天[1--144];P=0.18）及新生兒死亡率（6% vs. 11%;P=0.07）方面沒有顯著區(qū)別。

    Ismee Williams醫(yī)師

    首要研討者、紐約-長老會醫(yī)院/哥倫比亞大學(xué)醫(yī)學(xué)中間的胎兒心臟病教授Ismee Williams醫(yī)師表明，在2009年的論文宣布之后，產(chǎn)科醫(yī)師中的實習(xí)做法的確發(fā)生了革新，新生兒教授在這方面也起到了推進效果，我們都盡能夠不在39周之前臨產(chǎn)，并且不會給任何一位未到達(dá)39周的準(zhǔn)媽媽組織引產(chǎn)或是剖宮產(chǎn)。成果，從2004--2008年間到2010年這段時期內(nèi)，擇期剖宮產(chǎn)和擇期引產(chǎn)顯著削減，但緊迫引產(chǎn)、緊迫剖宮產(chǎn)以及發(fā)起產(chǎn)程后的剖宮產(chǎn)顯著添加。

    鑒于本研討是在先天分心臟病患者群中展開的，發(fā)生這種成果的一個能夠解說是大多數(shù)嬰兒在出院前都需求做手術(shù)。本研討未調(diào)查產(chǎn)婦的住院天數(shù)或其他產(chǎn)婦患病率目標(biāo)，但下一步能夠即是更詳盡地調(diào)查這種實習(xí)革新對產(chǎn)婦的影響。不過也有種能夠狀況是，對先天分心臟病人群而言，不論是不是在38周或39周臨產(chǎn)，都看不到在新生兒結(jié)局方面有很大區(qū)別，或是對住院天數(shù)等發(fā)病率重要目標(biāo)有很大影響。

    研討者們無利益沖突聲明。

    By: BIANCA NOGRADY, Cardiology News Digital Network

    SYDNEY – A shift in practice away from elective late preterm delivery to early term deliveries has shown little effect on neonatal outcomes such as intensive care length of stay, neonatal morbidity, or mortality in a population with major congenital heart disease, a study has found.

    Researchers at Columbia University Medical Center and Morgan Stanley Children's Hospital, both in New York, sought to evaluate the effect of a change in delivery practice that was introduced following the 2009 publication of a study showing improved outcomes in infants delivered after 39 weeks.

    A review of the medical records of infants with critical congenital heart disease compared outcomes in 878 infants born at a single tertiary center during 2004-2008 to outcomes in 124 infants born in 2010, after the change in practice had been implemented.

    There was a significant increase in the mean gestational age （37.8 weeks vs. 38.4 weeks, respectively; P less than .01） and in mean birth weight （2,975 grams vs. 3,134 grams; P less than .01）。

    However there were no significant differences between 2004-2008 and 2010 data in 5-minute APGAR scores （8.5 vs. 8.6; P = .11）， median length of stay （14 days [1-197] vs. 16 days [1-144]; P = .18） and neonatal mortality （6% vs. 11%; P = .07）， according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

    “After the 2009 paper came out, there was a real shift in practice among obstetricians – and also pushed by neonatologists – to try to not deliver patients before 39 weeks,” said researcher and fetal cardiologist Dr. Ismee Williams, of New York–Presbyterian Hospital/Columbia University Medical Center.

    “Then our goal, instead of being 38 weeks, was 39 weeks, and we would not schedule anybody for induction or a cesarean section unless they were 39 weeks and change,” Dr. Williams said in an interview.

    As a result of the change in practice, there were significant decreases in scheduled cesarean delivery from 2004-2008 to 2010 and in scheduled induction, but significant increases in urgent inductions, urgent cesarean deliveries, and cesarean deliveries after labor.

    “We were happy to see that the change did affect a consequent increase in gestational age and birth weight, but we were somewhat surprised that it didn't affect length of stay,” Dr. Williams said.

    Given that the study was conducted in a population with congenital heart disease, she said a likely explanation was that most of the infants would require surgery before they were discharged from hospital.

    Dr. Williams said that the study didn't look at maternal length of stay in hospital or other indicators of maternal morbidity, but she noted perhaps the next step would be to examine more closely the effect of the change in practice on mothers.

    “However, it's possible that, in the congenital heart disease population, whether or not you deliver at 38 or 39 weeks, we're not seeing that big of a difference in terms of the neonatal outcomes or a big impact on big markers of morbidity like length of stay,” Dr. Williams said.

    There were no conflicts of interest declared.