悉尼--依据国际妇产科超声学会（ISUOG）国际大会上发布的一项研讨，关于患有严峻先天分心脏病的胎儿，从择期晚期早产转变至前期临产对重症监护时刻、新生儿患病率或死亡率等新生儿结局影响甚微。
2009年宣布的一项研讨标明，39周后临产的婴幼儿结局有所改善，尔后根据这一成果，产科临产实习发生了革新。为了评估这种实习做法上的革新所形成的影响，哥伦比亚大学医学中间及摩根斯坦利儿童医院的研讨者们进行了本研讨。他们对危重先天分心脏病患儿的病历进行了检查，并将878名于2004--2008年间在一家三级医疗中间出世的婴幼儿的结局与124名在2010年（即施行革新之后）出世的婴幼儿进行对比。
成果显现，后一组婴儿出世时的均匀胎龄（分别为37.8周vs. 38.4周；P<0.01）及均匀体重（2,975 g vs. 3,134 g;P<0.01）显著添加，但在5分钟APGAR评分（8.5vs.8.6;P=0.11）、中位住院天数（14天[1--197] vs. 16 天[1--144];P=0.18）及新生儿死亡率（6% vs. 11%;P=0.07）方面没有显著区别。
Ismee Williams医师
首要研讨者、纽约-长老会医院/哥伦比亚大学医学中间的胎儿心脏病教授Ismee Williams医师表明，在2009年的论文宣布之后，产科医师中的实习做法的确发生了革新，新生儿教授在这方面也起到了推进效果，我们都尽能够不在39周之前临产，并且不会给任何一位未到达39周的准妈妈组织引产或是剖宫产。成果，从2004--2008年间到2010年这段时期内，择期剖宫产和择期引产显著削减，但紧迫引产、紧迫剖宫产以及发起产程后的剖宫产显著添加。
鉴于本研讨是在先天分心脏病患者群中展开的，发生这种成果的一个能够解说是大多数婴儿在出院前都需求做手术。本研讨未调查产妇的住院天数或其他产妇患病率目标，但下一步能够即是更详尽地调查这种实习革新对产妇的影响。不过也有种能够状况是，对先天分心脏病人群而言，不论是不是在38周或39周临产，都看不到在新生儿结局方面有很大区别，或是对住院天数等发病率重要目标有很大影响。
研讨者们无利益冲突声明。
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.
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