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新发现不支持低危妊娠晚期进行常规超声检查
作者:小柯机器人 发布时间:2019/10/17 12:45:58

荷兰阿姆斯特丹大学医学中心Ank de Jonge研究组的一项最新研究,分析了常规妊娠晚期超声检查对降低低危妊娠围产儿不良结局的有效性。2019年10月15日,《英国医学杂志》在线发表了这一成果。

2015年2月1日至2016年2月29日,荷兰的60个助产机构共招募了13520名孕中期的妇女,平均孕周为22.8周。根据荷兰全国围产期登记处或医院记录,共分析13046名妇女,其中5979名接受常规护理,即连续测量宫高和临床指示超声;7067名在常规护理的基础上接受干预措施,即在妊娠28-30周和34-36周接受两次常规生物监测扫描。

最终干预组分娩时小于胎龄儿的发生率为32%,显著高于常规护理组(19%)。干预组的严重不良围产儿结局发生率为1.7%,常规护理组为1.8%。校正混杂因素后,两组间差异不显著。干预组的引产率较高,但催产素催产的发生率较低。

总之,在低危妊娠中,孕晚期常规超声检查结合临床指征超声检查,可提高小于胎龄儿的产前检出率,但与常规护理相比,并不能降低严重不良围产儿结局的发生率。该发现不支持低危妊娠晚期进行常规超声检查。

附:英文原文

Title: Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial

Author: Jens Henrichs, Viki Verfaille, Petra Jellema, Laura Viester, Eva Pajkrt, Janneke Wilschut, Henritte E van der Horst, Arie Franx, Ank de Jonge

Issue&Volume: 2019/10/15

Abstract: 

Objectives To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions.

Design Pragmatic, multicentre, stepped wedge cluster randomised trial.

Setting 60 midwifery practices in the Netherlands.

Participants 13 046 women aged 16 years or older with a low risk singleton pregnancy.

Interventions 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks’ gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies.

Main outcome measures The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth.

Results Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies.

Conclusion In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies.

DOI: 10.1136/bmj.l5517

Source: https://www.bmj.com/content/367/bmj.l5517

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj