Postpartum maternal mortality and cesarean delivery
Postpartum maternal mortality and cesarean delivery
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DOI：
10.1097/01.aog.0000233154.62729.24
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发表时间：
2006-09-01
影响因子：
7.2
通讯作者：
Breart, Gerard
中科院分区：
文献类型：
--
作者：
Deneux-Tharaux, Catherine;Carmona, Elodie;Breart, Gerard
目的：在过去的几十年中，许多国家的剖宫产率持续上升。这一趋势促使出现了一个有争议的辩论的风险和利益与剖宫产。我们的目的是提供一个有效的估计产后产妇死亡的风险直接相关的剖宫产阴道deliver.METHODS：一个基于人口的病例对照研究设计，从最近在法国全国范围内的调查中选择的主题。为了控制适应症偏倚，排除了因产前疾病导致的孕产妇死亡。在1996-2000年的5年研究期间，纳入了65个病例。对照组选自1998年法国全国围产期调查，包括10 244名妇女。多变量Logistic回归分析用于调整混杂因素。结果：调整潜在混杂因素后，剖宫产后的产后死亡风险是阴道分娩后的3.6倍（优势比3.64，95%可信区间2.15-6.19）。剖腹产和产时剖宫产都与显著增加的风险相关。剖腹产与麻醉并发症、产褥感染和静脉血栓栓塞导致的产妇死亡风险显著增加相关。产后出血死亡的风险没有显着差异阴道和剖腹产delivery.CONCLUSION：剖腹产与产后产妇死亡的风险增加。与这种过度风险相关的死亡原因的知识告知当代关于应要求剖宫产的讨论，并应告知预防策略。
OBJECTIVE: A continuous rise in the rate of cesarean delivery has been reported in many countries during the past decades. This trend has prompted the emergence of a controversial debate on the risks and benefits associated with cesarean delivery. Our objective was to provide a valid estimate of the risk of postpartum maternal death directly associated with cesarean as compared with vaginal delivery.METHODS: A population -based case-control study was designed, with subjects selected from recent nationwide surveys in France. To control for indication bias, maternal deaths due to antenatal morbidities were excluded. For the 5-year study period 1996-2000, 65 cases were included. The control group was selected from the 1998 French National Perinatal Survey and included 10,244 women. Multivariable logistic regression analysis was used to adjust for confounders.RESULTS: After adjustment for potential confounders, the risk of postpartum death was 3.6 times higher after cesarean than after vaginal delivery (odds ratio 3.64 95% confidence interval 2.15-6.19). Both preparturn and intraparturn cesarean delivery were associated with a significantly increased risk. Cesarean delivery was associated with a significantly increased risk of maternal death from complications of anesthesia, puerperal infection, and venous thromboembolism. The risk of death from postpartum hemorrhage did not differ significantly between vaginal and cesarean deliveries.CONCLUSION: Cesarean delivery is associated with an increased risk of postpartum maternal death. Knowledge of the causes of death associated with this excess risk informs contemporary discussion about cesarean delivery on request and should inform preventive strategies.