Background
Although blood pressure in singleton pregnancies is related to multiple adverse pregnancy outcomes, the blood pressure threshold has been controversial.
Objective
To explore the blood pressure reference threshold of singleton pregnant women in the second and third trimesters.
Study design
A bidirectional single-centre cohort study was undertaken. Clinical data were collected for women with singleton pregnancies who underwent regular antenatal examinations and delivered at Peking Union Medical College Hospital between July 2020 and June 2023. Blood pressure was recorded at 20–24 and 28–32 weeks of gestation, and hypertension and pre-eclampsia were used as the primary outcomes. The percentiles of blood pressure were calculated, and the 95th percentile was used as the upper limit for the second and third trimesters of pregnancy. Poisson regression was used to calculated adjusted relative risk (aRR) and 95 % confidence intervals (CI) were used to analyse the relationship between elevated blood pressure and adverse pregnancy outcomes, and to further explore the impact of changes in blood pressure in the second and third trimesters on pregnancy outcomes. p-values < 0.05 were considered to indicate significance.
Results
In total, 7854 pregnant women with singleton pregnancies were included in this study. For pregnant women who did not experience adverse outcomes related to blood pressure, the 95th percentiles of systolic and diastolic blood pressure in the second trimester were 131 mmHg and 80 mmHg, respectively. Corresponding data for the third trimester were 130 mmHg and 80 mmHg, respectively. Therefore, 130/80 mmHg was taken as the upper limit of blood pressure. After excluding confounding factors, regardless of trimester, the risks of gestational hypertension, pre-eclampsia, preterm birth, low birth weight and neonatal intensive care unit (NICU) admission were found to be significantly higher in pregnant women with elevated blood pressure (p < 0.05). Pregnant women with sustained elevated blood pressure (i.e. in both the second and third trimesters) had aRR values for gestational hypertension, pre-eclampsia, premature birth, low birth weight and NICU admission that were 19.08 (95 % CI 13.04–28.03; p < 0.001), 11.43 (95 % CI 6.94–18.64; p < 0.001), 2.53 (95 % CI 1.83–3.42; p < 0.001), 2.98 (95 % CI 2.05–4.21; p < 0.001) and 1.79 (95 % CI 1.29–1.79; p < 0.001) times higher than those of normotensive pregnant women, respectively.
Conclusion
The blood pressure threshold of singleton pregnant women in the second and third trimesters is 130/80 mmHg. Sustained elevated blood pressure is harmful to the health of mothers and infants. Management and monitoring should be strengthened for pregnant women with elevated blood pressure.
虽然单胎妊娠的血压与多种不良妊娠结局有关，但血压阈值一直存在争议。目的探讨妊娠中晚期单胎孕妇的血压参考阈值。研究设计进行了一项双向单中心队列研究。收集2020年7月至2023年6月期间在北京协和医院定期进行产前检查并分娩的单胎妊娠妇女的临床资料。记录妊娠20-24周和28-32周时的血压，以高血压和先兆子痫为主要结局。计算血压的百分位数，以第95百分位数作为妊娠中期和晚期的上限。采用泊松回归计算校正相对危险度（aRR），采用95% %置信区间（CI）分析血压升高与不良妊娠结局的关系，进一步探讨妊娠中晚期血压变化对妊娠结局的影响。p值<； 0.05认为具有显著性。结果本研究共纳入单胎妊娠7854例。对于没有经历与血压相关的不良后果的孕妇，妊娠中期收缩压和舒张压的第95百分位分别为131 mmHg和80 mmHg。妊娠晚期相应数据分别为130 mmHg和80 mmHg。因此以130/80 mmHg作为血压上限。排除混杂因素后，不论妊娠期，血压升高孕妇发生妊娠高血压、子痫前期、早产、低出生体重和入住新生儿重症监护病房（NICU）的风险均显著增高（p <； 0.05）。持续血压升高的孕妇（即妊娠中期和妊娠晚期）的妊娠高血压、先兆子痫、早产、低出生体重和入住新生儿重症监护病房的aRR值为19.08(95% % CI 13.04-28.03；p <； 0.001),11.43(95 % CI 6.94-18.64；p <； 0.001),2.53(95 % CI 1.83-3.42；p <； 0.001),2.98(95 % CI 2.05-4.21；p <； 0.001)和1.79(95 % CI 1.29-1.79；P <； 0.001)分别比血压正常孕妇高1倍。结论单胎妊娠中晚期血压阈值为130/80 mmHg。持续升高的血压对母亲和婴儿的健康有害。对孕妇血压升高应加强管理和监测。
引用次数: 0
Exposure to violence and risk of hypertensive disorders in pregnancy: Systematic review and meta-analysis
妊娠期暴露于暴力和高血压疾病风险：系统回顾和荟萃分析
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-05-17
DOI: 10.1016/j.eurox.2025.100398
Background
Hypertensive disorders during pregnancy (HDP) are a significant global health concern, affecting 5–10 % of pregnancies and contributing to maternal and newborn morbidity and mortality. While various factors, including genetics and physiological changes, influence the development of HDP, emerging evidence suggests a strong association with psychosocial stressors, particularly exposure to violence. This meta-analysis aimed to assess the association between exposure to violence and risk of hypertensive disorders in pregnancy.
Methods
A literature review was performed across EMBASE, PubMed, and Web of Science from their inception until October 2024. The review included observational studies that examined exposure to various type of violence and their association with hypertensive disorders in pregnancy. Pooled effect estimates, including odds ratios (ORs) and relative risks (RRs) were computed using a random-effects model.
Results
Sixteen studies met the inclusion criteria. Meta-analysis revealed that violence exposure during pregnancy was associated with a significantly increased risk of HDP, with a pooled OR of 1.380 (95 % CI: 1.079–1.765) and a pooled RR of 1.235 (95 % CI: 1.074–1.420). Subgroup analysis indicated that cohort studies demonstrated a stronger association (OR: 1.726, 95 % CI: 1.182–2.519) compared to cross-sectional studies (OR: 1.112, 95 % CI: 1.009–1.226).
Conclusion
Experiencing violence during pregnancy is significantly linked to a heightened risk of HDP, indicating the need for regular violence screening and early preventive measures in prenatal care. Public health initiatives focused on reducing violence against women, especially during pregnancy, are crucial for improving maternal health and lowering the incidence of hypertensive complications.
妊娠期高血压疾病（HDP）是一个重大的全球健康问题，影响5 - 10% 的妊娠，并导致孕产妇和新生儿发病率和死亡率。虽然包括遗传和生理变化在内的各种因素影响HDP的发展，但新出现的证据表明，HDP与心理社会压力源，特别是暴露于暴力有密切联系。本荟萃分析旨在评估暴力暴露与妊娠期高血压疾病风险之间的关系。方法对EMBASE、PubMed和Web of Science从建立到2024年10月的文献进行综述。该综述包括观察性研究，这些研究调查了怀孕期间暴露于各种类型的暴力及其与高血压疾病的关系。使用随机效应模型计算合并效应估计，包括优势比（ORs）和相对风险（rr）。结果16项研究符合纳入标准。荟萃分析显示，怀孕期间暴力暴露与HDP风险显著增加相关，合并OR为1.380(95 % CI: 1.079-1.765)，合并RR为1.235（95 % CI: 1.074-1.420）。亚组分析表明，与横断面研究（OR: 1.112, 95 % CI: 1.009-1.226）相比，队列研究显示出更强的相关性（OR: 1.726, 95 % CI: 1.182-2.519）。结论：怀孕期间遭受暴力与HDP风险增加显著相关，表明在产前护理中需要定期进行暴力筛查和早期预防措施。侧重于减少对妇女的暴力行为，特别是在怀孕期间的暴力行为的公共卫生举措，对于改善孕产妇保健和降低高血压并发症的发生率至关重要。
引用次数: 0
The diagnostic potential of elastosonography in cesarean scar pregnancy
弹性超声在剖宫产瘢痕妊娠中的诊断价值
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-05-16
DOI: 10.1016/j.eurox.2025.100399
Background
Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy where the embryo implants in the scar from a previous cesarean section. CSP is a high-risk condition that can cause serious complications, such as uterine rupture and life-threatening bleeding. This study investigated the accuracy and reliability of elastosonography in diagnosing CSP.
Method
A prospective cohort study was conducted at Mardin Training and Research Hospital (Turkey) between October 2023 and January 2024. The study included 61 patients with CSP and a separate control group of 61 patients, all between 6 and 12 weeks of gestation. Both groups were evaluated using elastosonography.
Results
Elastosonography parameters, including strain ratio, myometrial shear wave velocity, and scar hardness, were significant in diagnosing CSP. Age, BMI, parity, and number of previous cesarean sections did not significantly correlate with elastosonography findings. Beta-hCG and fetal heart rate were not significant diagnostic factor
Conclusion
Elastosonography shows promise as a diagnostic tool for CSP. Further research is needed to confirm its clinical utility.
剖宫产疤痕妊娠（CSP）是一种罕见的异位妊娠，胚胎植入以前剖宫产的疤痕。CSP是一种高风险的疾病，可导致严重的并发症，如子宫破裂和危及生命的出血。本研究探讨弹性超声诊断CSP的准确性和可靠性。方法于2023年10月至2024年1月在土耳其马尔丁培训与研究医院进行前瞻性队列研究。该研究包括61例CSP患者和61例妊娠6至12周的单独对照组。两组均采用弹性超声进行评价。结果超声参数应变比、肌层剪切波速、瘢痕硬度对CSP诊断有重要意义。年龄、体重指数、胎次和既往剖宫产次数与弹性超声检查结果无显著相关性。结论弹性超声作为CSP的诊断工具具有良好的应用前景。需要进一步的研究来证实其临床应用。
引用次数: 0
Risk factors of recurrent cervical intraepithelial neoplasm 2/3 after primary excisional conization/LEEP treatments: A follow-up nationwide cohort study
原发性切除锥切/LEEP治疗后复发宫颈上皮内肿瘤2/3的危险因素：一项全国随访队列研究
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-05-14
DOI: 10.1016/j.eurox.2025.100397
Objective
Follow-up human papillomavirus (HPV) testing 6 months after treatment is suggested for women with cervical intraepithelial neoplasm (CIN) 2/3. However, the Pap smear remains the only feasible tool in areas with limited resources. Our study aimed to evaluate the risk factors of recurrent CIN2/3 after excision treatment by follow-up Pap smear in a nationwide database.
Methods
We retrospectively identified women receiving excision treatment for CIN2/3 from 2007 to 2016 in the Taiwan National Cervical Cancer Screening Database. Risk factors of recurrence including age, education status, follow-up frequency, and the results of serial follow-up Pap smears were analyzed.
Results
In total, 11595 women were enrolled, 287 having recurrent CIN2 + diseases (cumulative incidence of recurrence of 24.8/1000 people). The incidence of recurrent CIN2 + lesions was highest in the over 60-year-old age group (12.12/1000 person-years). For the first follow-up Pap smear, the highest recurrence rate was in the AGC/HSIL+ group (106.6/1000 people). Multivariate Cox regression analysis revealed that over 60 years of age, AGC/HSIL+ in the first follow-up pap smear, and any abnormal pap smear result within the first year after treatment were risk factors of CIN2/3 recurrence.
Conclusions
In patients receiving excision for CIN2/3, the recurrence risk was higher in patients older than 60 years of age, and who had any abnormal follow-up Pap smear results, especially AGC/HSIL+ , in the first year after treatment.
目的建议宫颈上皮内肿瘤（CIN） 2/3患者治疗后6个月随访人乳头瘤病毒（HPV）检测。然而，在资源有限的地区，子宫颈抹片检查仍然是唯一可行的工具。我们的研究旨在评估CIN2/3切除术后复发的危险因素，通过随访巴氏涂片检查全国数据库。方法回顾性分析2007年至2016年在台湾宫颈癌筛查数据库中接受CIN2/3切除治疗的女性。分析复发的危险因素包括年龄、文化程度、随访频率和系列随访子宫颈抹片检查结果。结果共入组妇女11595例，其中287例为复发性CIN2 + 疾病（累计复发率为24.8/1000人）。复发CIN2 + 病变的发生率在60岁以上年龄组最高（12.12/1000人年）。在第一次随访子宫颈抹片检查中，AGC/HSIL+ 组复发率最高（106.6/1000人）。多因素Cox回归分析显示，60岁以上、首次随访子宫颈抹片AGC/HSIL+ 、治疗后1年内任何子宫颈抹片结果异常均为CIN2/3复发的危险因素。结论在接受CIN2/3切除术的患者中，年龄大于60岁且随访子宫颈抹片检查结果异常，特别是治疗后1年AGC/HSIL+ 的患者复发风险较高。
引用次数: 0
Immediate skin-to-skin contact after caesarean section – A simulation study
剖宫产术后即刻皮肤接触-模拟研究
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-05-14
DOI: 10.1016/j.eurox.2025.100392
Background
Performing a caesarean section using a drape with a transparent window between the mother and the surgical area has not been studied previously.
Aim
To describe ways of passing a baby to the mother for skin-to-skin contact after caesarean section, and to analyse the time lapse between cutting the umbilical cord and placement of the baby on the mother.
Methods
Simulation characters were used as study subjects. Three methods of passing a baby to the mother for skin-to-skin contact after caesarean section were assessed. In the first method, an opaque drape was placed between the mother and the surgical area, so the mother could not see the baby being born. The surgeon passed the baby to the midwife, who placed the baby on the mother for skin-to-skin contact. In the second method, the mother was able to see the baby being born through a transparent drape. The baby was otherwise handled as in the first method. In the third method, a transparent drape with a window was placed between the mother and the surgical area, so the mother could see the baby being born. The baby was passed through the window in the drape and placed on the mother for skin-to-skin contact. The time lapse between cutting the umbilical cut and skin-to-skin contact was analysed for the three methods.
Results
For the first and second methods, the time between cutting the umbilical cord and skin-to-skin contact ranged from 11 to 15.5 s. For the third method, the time was 20–29 s. A minor technical difficulty was noted for the third method.
Conclusion
Passing a baby to the mother through a transparent drape with a window after caesarean section is not superior in terms of time, but may improve bonding between the mother and baby.
背景：在母亲和手术区域之间使用带有透明窗口的帷幔进行剖宫产手术，以前没有研究过。目的描述剖宫产后将婴儿传递给母亲进行皮肤接触的方法，并分析从切断脐带到将婴儿放置在母亲身上的时间间隔。方法以模拟性状为研究对象。评估了剖宫产后将婴儿传给母亲进行皮肤接触的三种方法。在第一种方法中，在母亲和手术区域之间放置不透明的帷幔，因此母亲无法看到婴儿出生。外科医生把婴儿递给助产士，助产士把婴儿放在母亲身上进行皮肤接触。在第二种方法中，母亲可以通过透明的帘子看到婴儿出生。按照第一种方法处理婴儿。在第三种方法中，在母亲和手术区域之间放置一个带窗户的透明窗帘，这样母亲就可以看到婴儿出生。婴儿从窗帘上的窗户穿过，放在母亲身上进行皮肤接触。分析了三种方法切割脐带切口与皮肤接触之间的时间间隔。结果第一种方法与第二种方法的脐带剪断时间为11 ~ 15.5 s。第三种方法的时间为20-29 s。注意到第三种方法有一个小小的技术困难。结论剖宫产术后经带窗透明纱布传递给母亲在时间上并不占优势，但可改善母婴关系。
引用次数: 0
Splenectomy during cytoreductive surgery in advanced epithelial ovarian cancer can be predicted
晚期上皮性卵巢癌在细胞减数术中进行脾切除术是可以预测的
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-05-09
DOI: 10.1016/j.eurox.2025.100395
Introduction
Splenectomy may be necessary for complete cytoreductive surgery (CRS) in advanced stage epithelial ovarian cancer (AS-EOC), potentially raising perioperative morbidity and necessitating specific patient management.
Objective
This study aimed to develop a predictive score of splenectomy in CRS of AS-EOC.
Materials and methods
Data from histologically confirmed AS-EOC (FIGO IIB-IV) before CRS and diagnosed between 01/01/2000 and 01/06/2017, were extracted from the FRANCOGYN multicentric database (14 French hospitals). After identifying predictive factors of splenectomy, we performed a logistic regression to develop a prediction model and construct a risk score, allowing identification of a high-risk group. Model discrimination was assessed using a Receiver Operating Characteristic (ROC) curve. Decision Curve Analysis (DCA) was then conducted to evaluate the model’s net clinical benefit across a range of threshold probabilities.
Results
Among 1288 patients included, 7 % (n = 91) underwent splenectomy. Four independent variables statistically associated with splenectomy were identified: age < 60 years (aDOR = 1.76, 95 % CI [1.13–2.75], p = 0.015), omental cake (aDOR = 2.12, 95 % CI [1.11–4.08], p = 0.024), diaphragmatic carcinosis (aDOR = 2.36, 95 % CI [1.34–4.18], p = 0.001), and digestive involvement at initial CT and/or laparoscopy (aDOR = 3.24, 95 % CI [1.93–5.43], p < 0.001). The ROC-AUC of this prediction model was 0.76. Patients meeting all 4 criteria with a maximum of 10 points defined the high-risk group and had a splenectomy probability of 32 % (95 % CI [22.00–44.31]), with a specificity of 95.8 % (95 % CI [94.5–96.9]) and a positive likelihood ratio of 6.31 (95 % CI [4.08–9.78]). The DCA showed a positive net clinical benefit of the model between 15 % and 40 % threshold probabilities.
Conclusion
Using a simple 4 – variable predictive score, patients at high risk of splenectomy during CRS in AS-EOC could be identified to improve patients’ preoperative information and perioperative management.
在晚期上皮性卵巢癌（AS-EOC）的完全细胞减少手术（CRS）中，脾切除术可能是必要的，这可能会增加围手术期的发病率，并需要特定的患者管理。目的建立AS-EOC CRS患者脾切除术的预测评分。材料和方法2000年1月1日至2017年6月1日诊断的CRS前组织学证实的AS-EOC （FIGOⅱb -ⅳ）数据提取自FRANCOGYN多中心数据库（法国14家医院）。在确定了脾切除术的预测因素后，我们进行了逻辑回归，建立了预测模型并构建了风险评分，从而确定了高危人群。采用受试者工作特征（ROC）曲线评估模型判别。然后进行决策曲线分析（DCA），以评估该模型在一系列阈值概率范围内的净临床效益。结果1288例患者中，7 % （n = 91）行脾切除术。确定了四个独立变量统计与脾切除术:年龄& lt; 60年(大使= 1.76,95 % CI [1.13 - -2.75], p = 0.015),网膜的蛋糕(大使= 2.12,95 % CI [1.11 - -4.08], p = 0.024),横隔膜癌病(大使= 2.36,95 % CI [1.34 - -4.18], p = 0.001),和消化介入在初始CT和/或腹腔镜检查(大使= 3.24,95 % CI [1.93 - -5.43], p & lt; 0.001)。该预测模型的ROC-AUC为0.76。所有4项标准均满足且总分最高为10分的患者定义为高危组，脾切除术概率为32 %(95 % CI[22.00-44.31])，特异性为95.8 %(95 % CI[94.5-96.9])，阳性似然比为6.31（95 % CI[4.08-9.78]）。DCA显示该模型的净临床效益在15% %和40% %的阈值概率之间。结论采用简单的4变量预测评分，可识别AS-EOC CRS中脾切除术高危患者，提高患者术前信息和围手术期管理水平。
引用次数: 0
Predictors of delivery at 48 hours or more in pregnant women with preterm prelabor rupture of membrane: A retrospective cohort study
早产胎膜破裂孕妇48 小时或以上分娩的预测因素：一项回顾性队列研究
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-05-01
DOI: 10.1016/j.eurox.2025.100393
Objective
Expectant management is an option for preterm prelabor rupture of the membrane (PPROM) between 34 0/7 and 36 6/7 weeks of gestation. Even though expectant delivery in PPROM is justified, there is limited data on predictors of PPROM delivered > 48 hrs in a real-world setting. Therefore, this study aimed to find clinical predictors for delivery > 48 hrs in women with PPROM as well as clinical outcomes in clinical practice.
Materials and methods
This was a retrospective cohort study conducted at two tertiary care hospitals. The inclusion criteria were a singleton pregnancy with PPROM and planned expectant management. Clinical data were retrieved from the hospitals’ databases. Eligible pregnant women were categorized into two groups: PPROM delivered < 48 hrs or PPROM delivered > 48 hrs. The primary outcome was factors predictive of PPROM delivered > 48 hrs.
Results
During the study period, 519 pregnant women met the study criteria. Of those, 90 pregnant women (17.34 %) had PPROM delivered > 48 hrs. Factors independently associated with PPROM delivered > 48 hrs were maternal age ≥ 19 years (adjusted odds ratio [aOR] 0.95, 95 % CI [0.91, 0.99]) and oligohydramnios (aOR 2.41, 95 % CI [1.45, 4.00]). Regarding maternal and neonatal outcomes, the PPROM delivered > 48 hrs group had lower neonatal birth weights (2245 g vs. 2490 g; p < 0.001) than the PPROM delivered < 48 hrs group. However, neonatal outcomes, including respiratory distress, sepsis, neonatal intensive care unit admission, early jaundice, hypoglycemia, positive pressure ventilation, and early respiratory support, were not different.
Conclusions
Clinical predictors for PPROM delivered > 48 hrs in a real-world setting were maternal age and presence of oligohydramnios. Maternal and neonatal outcomes in the PPROM delivered > 48 hrs were almost comparable with the PPROM delivered < 48 hrs. PPROM delivered > 48 hrs may be safe and can be a treatment option for PPROM. However, further studies may be required in terms of generalizability as this study was conducted retrospectively in tertiary care hospitals in Thailand.
目的对妊娠34 0/7 ~ 36 6/7周间的早产胎膜破裂（PPROM）进行准产治疗。尽管PPROM的预期分娩是合理的，但在现实环境中，预测PPROM分娩>； 48小时的数据有限。因此，本研究旨在寻找PPROM妇女分娩>； 48小时的临床预测因素以及临床实践中的临床结局。材料和方法本研究是在两家三级医院进行的回顾性队列研究。纳入标准为单胎妊娠伴PPROM和计划待产管理。临床数据从医院的数据库中检索。符合条件的孕妇被分为两组：PPROM分娩<； 48小时或PPROM分娩>； 48小时。主要结局是预测PPROM发生的因素>； 48小时。结果在研究期间，519名孕妇符合研究标准。其中90例孕妇（17.34 %）发生PPROM分娩>； 48小时。与PPROM分娩>； 48小时独立相关的因素是产妇年龄≥ 19岁（调整优势比[aOR] 0.95, 95 % CI[0.91, 0.99]）和羊水过少（aOR 2.41, 95 % CI[1.45, 4.00]）。关于产妇和新生儿结局，PPROM分娩>； 48小时组新生儿出生体重较低(2245 g vs. 2490 g；p <； 0.001)比PPROM交付<； 48小时组。然而，新生儿结局，包括呼吸窘迫、败血症、新生儿重症监护病房入院、早期黄疸、低血糖、正压通气和早期呼吸支持，没有差异。结论在现实世界中分娩PPROM >； 48小时的临床预测因素是产妇年龄和羊水过少。PPROM分娩>； 48小时与PPROM分娩<； 48小时的产妇和新生儿结局几乎相当。PPROM交付>； 48小时可能是安全的，可以作为PPROM的治疗选择。然而，由于本研究是在泰国三级医院回顾性进行的，因此可能需要进一步的研究来推广。
引用次数: 0
Escalating caesarean deliveries and the impact on subsequent preterm birth
不断增加的剖腹产及其对随后早产的影响
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-04-26
DOI: 10.1016/j.eurox.2025.100391
The rate of caesarean section, including those performed in-labour, is on the rise. Worldwide 1 in 5 women are delivering by caesarean section. Emerging evidence has demonstrated an association between in-labour caesarean section and mid-trimester loss (delivery between 14 and 24 weeks gestation) as well as spontaneous preterm birth, (delivery before 37 weeks’ gestation). This problem is more likely to recur in subsequent pregnancies and is difficult to treat with evidence suggesting that transvaginal cerclage may be a less efficacious preventative measure in women with a short cervix and previous in-labour caesarean section. This review explores the scope of the issue including the evidence for in-labour caesarean section as a risk factor for preterm birth and the possible underlying mechanism. It will discuss management strategies, as well as highlighting areas where further research is required.
剖宫产率，包括在分娩过程中进行的剖宫产率正在上升。全世界五分之一的妇女通过剖腹产分娩。新出现的证据表明，产程剖腹产与中期妊娠流产（妊娠14至24周之间分娩）以及自然早产（妊娠37周之前分娩）之间存在关联。这一问题在随后的妊娠中更有可能复发，并且很难治疗，有证据表明，对于宫颈短和曾经进行过分娩剖腹产的妇女，经阴道环切术可能是一种效果较差的预防措施。这篇综述探讨了这个问题的范围，包括产中剖腹产作为早产危险因素的证据和可能的潜在机制。它将讨论管理战略，并强调需要进一步研究的领域。
引用次数: 0
Association between different types and characteristics of fetal deceleration during labour and neonatal acidemia at delivery: A case-control study
产程中胎儿减速的不同类型和特征与分娩时新生儿酸血症之间的关系：一项病例对照研究
IF 1.5
Q3 OBSTETRICS & GYNECOLOGY
Pub Date : 2025-04-25
DOI: 10.1016/j.eurox.2025.100389
Objective
Classification of fetal heart rate (FHR) decelerations as suspicious or pathological differs between current interpretation templates for intrapartum cardiotocography. Decelerations are the most frequent FHR pattern irregularities during labour. The aim of this study was to assess the association between different types and characteristics of decelerations and acidemia at birth.
Methods
This case-control study includes 365 cases with cord pH < 7.10 after 1st stage cesarean delivery or pH < 7.05 after vaginal delivery at > 34 + 0 weeks after induced or spontaneous labour, and 730 controls with pH ≥ 7.15. Cardiotocographic recordings from 60 min before birth were scrutinized and decelerations evaluated in detail. Odds ratios (OR) with 95 % confidence intervals for acidemia at birth were determined.
Results
The following types of decelerations were associated with acidemia: Late decelerations; OR 9.0 (6.1–13) if > 5, and OR 19 (9.7–37) if repetitive > 20 min, combined decelerations; OR 4.2 (2.7–6.4) if > 5 and OR 6.4 (3.1–13) if repetitive > 20 min, one prolonged deceleration > 5 min; OR 12 (7.9–19), three prolonged decelerations for 3–5 min; OR 10 (4.3–25), and > 5 variable decelerations > 60 s; OR 2.2 (1.6–2.9). For variable decelerations > 60 s, absent variability within decelerations was the only additional characteristic significantly associated with acidemia; OR 5.8 (2.1–16). A strong association with acidemia was noted for a FHR below the baseline ≥ 50 % of the time > 30 min; OR 14 (10−19).
Conclusion
Late and prolonged decelerations are strongly, and combined decelerations moderately associated with acidemia. The risk of acidemia is highly increased if FHR is below baseline ≥ 50 % of the time.
目的探讨目前产程心术诊断模板对可疑或病理性胎儿心率减慢的分类差异。减速是分娩期间最常见的FHR模式异常。本研究的目的是评估不同类型和特征的减速和出生时酸血症之间的关系。方法本病例对照研究纳入365例1期剖宫产后脐带pH <； 7.10或引产或自然分娩后0周阴道分娩后pH <； 7.05，以及730例pH≥ 7.15的对照组。检查出生前60 分钟的心动图记录，并详细评估减速。确定出生时酸血症的比值比（OR）为95% %置信区间。结果下列类型的减速与酸血症相关：迟发减速；如果>； 5，OR为9.0(6.1-13)，如果重复>； 20 min， OR为19(9.7-37)，联合减速；如果>； 5,OR 4.2(2.7-6.4)，如果重复>； 20 min, OR 6.4(3.1-13)，一次延长减速>； 5 min；OR 12(7.9-19)，三次延长减速3-5 min；OR 10（4.3-25）和>； 5可变减速>； 60 s；或2.2（1.6-2.9）。对于可变减速>； 60 s，减速内缺乏可变性是与酸血症显著相关的唯一附加特征；或5.8（2.1-16）。与酸血症密切相关的是FHR低于基线≥ 50 %的时间>； 30 min；或14（10−19）。结论迟发性和长期性减速与酸血症密切相关，联合减速与酸血症中度相关。如果FHR低于基线≥ 50 %，则酸血症的风险会大大增加。
引用次数: 0
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