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 no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.展开更多
目的:分析不同临产状态子宫下段平滑肌组织中与NF-κB相互作用的差异蛋白质,为分娩机制的研究提供新的实验及理论依据。方法:分别采集足月未临产、自然临产和前列腺素E2栓诱导临产(药物临产组)的孕妇子宫下段平滑肌组织。Western印迹验...目的:分析不同临产状态子宫下段平滑肌组织中与NF-κB相互作用的差异蛋白质,为分娩机制的研究提供新的实验及理论依据。方法:分别采集足月未临产、自然临产和前列腺素E2栓诱导临产(药物临产组)的孕妇子宫下段平滑肌组织。Western印迹验证NF-κB P65表达;联合免疫共沉淀、SDS-PAGE、电喷雾串联质谱(LC-ESI-MS/MS)和蛋白质生物信息分析等技术,分析不同临产状态子宫平滑肌组织中与NF-κB相互作用的差异蛋白质,并利用Western印迹进行验证。结果:人类临产前后子宫下段平滑肌组织中NF-κB表达均为阳性,与NF-κB P65相互作用的差异蛋白,自然临产前后鉴定出9个,药物临产前后鉴定出5个,其中不同临产状态共同差异表达的蛋白3个,分别为热休克蛋白70(heat shock 70 k D protein,HSP70)、膜联蛋白A6和结蛋白,经Western印迹验证与蛋白表达相符。这些差异蛋白分别属于分子伴侣、信号转导、细胞骨架和能量代谢相关的蛋白质。结论:子宫平滑肌细胞中NF-κB通过与分子伴侣、信号传导、细胞骨架和能量代谢等相关的多种蛋白质相互作用,参与分娩的启动或调节。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 no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.
文摘目的:分析不同临产状态子宫下段平滑肌组织中与NF-κB相互作用的差异蛋白质,为分娩机制的研究提供新的实验及理论依据。方法:分别采集足月未临产、自然临产和前列腺素E2栓诱导临产(药物临产组)的孕妇子宫下段平滑肌组织。Western印迹验证NF-κB P65表达;联合免疫共沉淀、SDS-PAGE、电喷雾串联质谱(LC-ESI-MS/MS)和蛋白质生物信息分析等技术,分析不同临产状态子宫平滑肌组织中与NF-κB相互作用的差异蛋白质,并利用Western印迹进行验证。结果:人类临产前后子宫下段平滑肌组织中NF-κB表达均为阳性,与NF-κB P65相互作用的差异蛋白,自然临产前后鉴定出9个,药物临产前后鉴定出5个,其中不同临产状态共同差异表达的蛋白3个,分别为热休克蛋白70(heat shock 70 k D protein,HSP70)、膜联蛋白A6和结蛋白,经Western印迹验证与蛋白表达相符。这些差异蛋白分别属于分子伴侣、信号转导、细胞骨架和能量代谢相关的蛋白质。结论:子宫平滑肌细胞中NF-κB通过与分子伴侣、信号传导、细胞骨架和能量代谢等相关的多种蛋白质相互作用,参与分娩的启动或调节。
