Mode of Delivery in Nulliparous Women and Neonatal Intracranial Injury
Mode of Delivery in Nulliparous Women and Neonatal Intracranial Injury
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DOI：
10.1097/aog.0b013e31823835d3
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发表时间：
2011-12-01
影响因子：
7.2
通讯作者：
Lipkind, Heather S.
中科院分区：
文献类型：
--
作者：
Werner, Erika F.;Janevic, Teresa M.;Lipkind, Heather S.
目的：比较剖宫产，产钳辅助阴道分娩，真空辅助阴道分娩的新生儿神经系统并发症的发生率。方法：纽约市1995年至2003年未经产妇女在妊娠34周或更长时间的单胎活产数据与出院数据相关联。任何新生儿硬膜下出血、脑室内出血、癫痫发作、头皮裂伤或头部血肿、骨折、面神经麻痹、臂丛神经损伤或5分钟Apgar评分小于7的诊断均被认为是显著的。多变量Logistic回归估计分娩方式和这些新生儿morbidity.Results之间的关联：钳辅助阴道分娩与显着减少癫痫发作和5分钟Apgar评分小于7相比，真空辅助阴道分娩和剖宫产分娩。与产钳辅助阴道分娩或真空辅助阴道分娩相比，剖腹产与硬膜下血肿较少有关。当对癫痫发作、脑室内出血和硬膜下出血进行综合检查以最佳预测神经系统结局时，与真空辅助阴道分娩（比值比[OR] 0.60，95%置信区间[CI] 0.40-0.90）和剖宫产分娩（OR 0.68，95% CI 0.48-0.97）相比，钳辅助阴道分娩的总体风险降低。需要治疗，以防止一例严重的神经系统疾病的数量是509钳辅助阴道分娩相比，真空辅助阴道分娩和559钳辅助阴道分娩相比，剖宫产delivery.CONCLUSION：相比真空辅助阴道分娩或剖宫产，钳辅助阴道分娩与不良新生儿神经系统结局的风险降低。（妇产科2011;118：1239-46）DOI：10.1097/AOG.0b013e31823835d3
OBJECTIVE: To compare neonatal neurologic complication rates of cesarean deliveries, forceps-assisted vaginal deliveries, and vacuum-assisted vaginal deliveries.METHODS: Data on singleton live births at 34 weeks or greater gestation born to nulliparous women from 1995 to 2003 in New York City were linked to hospital discharge data. Any diagnosis of neonatal subdural hemorrhage, intraventricular hemorrhage, seizures, scalp laceration or cephalohematoma, fracture, facial nerve palsy, brachial plexus injury, or 5-minute Apgar score of less than 7 was considered significant. Multivariable logistic regression was used to estimate associations between delivery mode and these neonatal morbidities.RESULTS: Forceps-assisted vaginal deliveries were associated with significantly fewer seizures and 5-minute Apgar scores less than 7 compared with vacuum-assisted vaginal deliveries and cesarean deliveries. Cesarean deliveries were linked to less subdural hemorrhages compared with forceps-assisted vaginal deliveries or vacuum-assisted vaginal deliveries. When seizure, intraventricular hemorrhage, and subdural hemorrhage were examined collectively to best predict neurologic outcome, forceps-assisted vaginal deliveries had an overall reduced risk compared with both vacuum-assisted vaginal deliveries (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.40-0.90) and cesarean deliveries (OR 0.68, 95% CI 0.48-0.97). The number needed to treat to prevent one case of severe neurologic morbidity is 509 for forceps-assisted vaginal deliveries compared with vacuum-assisted vaginal deliveries and 559 for forceps-assisted vaginal deliveries compared with cesarean deliveries.CONCLUSION: Compared with vacuum-assisted vaginal delivery or cesarean delivery, a forceps-assisted vaginal delivery is associated with a reduced risk of adverse neonatal neurologic outcomes. (Obstet Gynecol 2011;118:1239-46) DOI: 10.1097/AOG.0b013e31823835d3