Risk of stillbirth following a cesarean delivery: black-white disparity.
Risk of stillbirth following a cesarean delivery: black-white disparity.
复制标题
剖腹产后死产的风险：黑白差异。
DOI：
10.1097/01.aog.0000195103.46999.32
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发表时间：
2006
影响因子：
7.2
通讯作者：
Kirby,RussellS
中科院分区：
文献类型：
--
作者：
Salihu,HamisuM;Sharma,PuzaP;Kristensen,Sibylle;Blot,Cassandra;Alio,AminaP;Ananth,CandeV;Kirby,RussellS
OBJECTIVE:We examine the association between prior cesarean delivery and risk of stillbirth in a subsequent pregnancy.METHODS:The Missouri maternally linked cohort data set containing births from 1978 through 1997 was used. We identified a cohort of women who delivered live births by cesarean delivery and a comparison cohort of women who delivered live births vaginally in their first pregnancies. We then compared the risks of stillbirth in the second pregnancy between the 2 groups.RESULTS:We analyzed 396,441 women with information on first and second pregnancies, comprising 71,950 (18.1%) in the cesarean arm, and 324,491 (81.9%) in the vaginal birth arm. Rates of stillbirth among women with and those without history of cesarean delivery were 4.4 and 4.1 per 1,000 births, respectively (P=. 2). The adjusted estimates also showed no difference in risk for stillbirth between the 2 groups (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.0–1.3). Among whites, the stillbirth rates in women with and those without history of cesarean delivery were 3.7 and 3.6 per 1,000 births, respectively (OR 1.0, 95% CI 0.9–1.2). Among blacks, both the absolute and the adjusted relative risks for stillbirth were elevated in mothers with history of cesarean delivery (stillbirth rate 9.3 versus 6.8 per 1,000 births; OR 1.4, 95% CI 1.1–1.7).CONCLUSION:Overall, our analysis did not detect an association between cesarean history and subsequent stillbirth. However, cesarean delivery may increase the risk for subsequent stillbirth among black mothers, a group with the highest cesarean delivery rate in the country.Level of Evidence:IIICesarean delivery elevates the risk for subsequent stillbirth in blacks but not in whites.After a decline during the period 1989–1996, the rate of cesarean delivery in the United States has been on the rise since then, with the current level being one-third higher than that for 1996 (cesarean delivery rate was 20.7% in 1996). 1, 2 Although both patient risk profiles and physician practice patterns are the main determinants of cesarean delivery, recent studies have found decreasing patient risk profiles for cesarean delivery over time, 3 an indication that changes in physician practice patterns rather than patient characteristics may be the dominant factor for increasing cesarean rates in the United States.
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