Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term
Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term
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DOI：
10.1503/cmaj.060870
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发表时间：
2007-02-13
影响因子：
14.6
通讯作者：
Kramer, Michael S.
中科院分区：
文献类型：
--
作者：
Liu, Shiliang;Liston, Robert M.;Kramer, Michael S.
背景资料：选择性初次剖腹产率继续上升，部分原因是普遍认为，该程序是很少或没有风险的健康women.Methods：使用加拿大卫生信息研究所的出院摘要数据库，我们进行了一项回顾性的人群为基础的队列研究，所有妇女在加拿大（不包括魁北克和马尼托巴）谁提供了从1991年4月至2005年3月。结果：计划剖宫产组46766例，计划阴道分娩组2292420例;在整个14年期间，每1 000名分娩的严重发病率分别为27.3和9.0。计划剖宫产组产后心脏骤停的风险增加（校正比值比[ OR] 5.1，95%置信区间[CI] 4.1 - 6.3），伤口血肿（OR 5.1，95% CI 4.6 - 5.5），子宫切除术（OR 3.2，95% CI 2.2 - 4.8），严重产褥期感染（OR 3.0，95% CI 2.7 - 3.4），麻醉并发症（OR 2.3，95% CI 2.0 - 2.6），静脉血栓栓塞（OR 2.2，95% CI 1.5 - 3.2）和需要子宫切除术的出血（OR 2.1，95% CI 1.2 - 3.8），住院时间更长（校正均数差1.47 d，95% CI 1.46 ~ 1.49 d），但需要输血的出血风险较低（OR 0. 4，95% CI 0. 2 - 0. 8）。严重孕产妇发病率的绝对风险增加较低（e.例如，在一个实施例中，对于产后心脏骤停，计划剖腹产的增加为1.6/1000分娩，95%CI 1.2 - 2.1）。两组间住院孕产妇死亡率的差异无显著性（p= 0.87）。解释：尽管绝对差异很小，但与计划剖宫产相关的严重孕产妇发病率的风险高于与计划阴道分娩相关的风险。这些风险应该被考虑妇女选择剖腹产和他们的医生。
Background: The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women.Methods: Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada ( excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate "planned cesarean group" considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally.Results: The planned cesarean group comprised 46 766 women v. 2 292 420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest ( adjusted odds ratio [ OR] 5.1, 95% confidence interval [CI] 4.1 - 6.3), wound hematoma ( OR 5.1, 95% CI 4.6 - 5.5), hysterectomy ( OR 3.2, 95% CI 2.2 - 4.8), major puerperal infection ( OR 3.0, 95% CI 2.7 - 3.4), anesthetic complications ( OR 2.3, 95% CI 2.0 - 2.6), venous thromboembolism ( OR 2.2, 95% CI 1.5 - 3.2) and hemorrhage requiring hysterectomy ( OR 2.1, 95% CI 1.2 - 3.8), and stayed in hospital longer ( adjusted mean difference 1.47 d, 95% CI 1.46 - 1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion ( OR 0.4, 95% CI 0.2 - 0.8). Absolute risk increases in severe maternal morbidity rates were low ( e. g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2 - 2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p= 0.87).Interpretation: Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.