Maternal morbidity associated with vaginal versus cesarean delivery
Maternal morbidity associated with vaginal versus cesarean delivery
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DOI：
10.1097/01.aog.0000124568.71597.ce
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发表时间：
2004-05-01
影响因子：
7.2
通讯作者：
Weber, AM
中科院分区：
文献类型：
--
作者：
Burrows, LJ;Meyn, LA;Weber, AM
目的：描述与足月分娩、单胎妊娠相关的产后产妇发病率。方法：对 1995 年至 2000 年的 Magee 产科医学和婴儿数据库进行了检查。将患者分为 6 种分娩方式：自然阴道分娩、手术阴道分娩、不试产的初次剖宫产、试产的初次剖宫产、重复剖宫产未经试产，并且 通过试产重复剖腹产。多变量逻辑回归提供了根据人口特征和合并症进行调整的分娩模式发病率的比值比和 95% 置信区间 (CI)。自然阴道分娩被用作参照组（比值比 = 1）。 结果：在 32,834 名受试者中，27,178 名受试者进行了阴道分娩（手术 = 4,908 名；自然分娩 = 22,270 名），5,656 名进行了剖腹产。阴道自然分娩的女性中有 1,733 名（7.8%）发生三度或四度撕裂伤，而阴道手术分娩的女性则有 1,098 名（22.3%）发生三度或四度撕裂伤。总体而言，523 名女性 (1.6%) 患有子宫内膜炎。与阴道自然分娩相比，初次剖腹产并试产的子宫内膜炎风险增加 21.2 倍（95% CI 15.4, 29.1）。即使没有试产，初次剖宫产后的女性患子宫内膜炎的可能性是自然阴道分娩后的 10.3 倍（95% CI 5.9, 17.9）。产后初次剖宫产的女性输血风险最高，比自然阴道分娩高 4.2 倍 (95% CI 1.8, 10.1)。再次剖宫产分娩后，肺炎风险增加 9.3 倍（95% CI 3.4, 25.6）。自然阴道分娩后有 15 例（0.1%）发生深静脉血栓，手术阴道分娩后有 2 例（0.04%）发生深静脉血栓，剖宫产后有 12 例（0.2%）发生深静脉血栓。结论：与自然阴道分娩相比，剖宫产与子宫内膜炎、输血需求和肺炎的风险增加相关；然而，这些比率低于之前报告的比率。 （(C) 2004 年，美国妇产科医师学会。）。
OBJECTIVE: To describe postpartum maternal morbidity associated with mode of delivery in term, singleton pregnancies.METHODS: The Magee Obstetric Medical and Infant database was examined for the years 1995 to 2000. Patients were grouped into 6 types of delivery mode: spontaneous vaginal delivery, operative vaginal delivery, primary cesarean delivery without trial of labor, primary cesarean delivery with trial of labor, repeat cesarean delivery without trial of labor, and repeat cesarean delivery with trial of labor. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) for morbidity by delivery mode adjusted for demographic characteristics and comorbidities. Spontaneous vaginal delivery was used as the referent group (odds ratio = 1).RESULTS: Of 32,834 subjects, 27,178 had vaginal delivery (operative = 4,908; spontaneous = 22,270) and 5,656 had cesarean delivery. Third- or fourth-degree lacerations occurred in 1,733 (7.8%) women who had spontaneous vaginal delivery compared with 1,098 (22.3%) who had operative vaginal delivery. Overall, 523 women (1.6%) had endometritis. Compared with spontaneous vaginal delivery, primary cesarean delivery with trial of labor conferred a 21.2-fold increased risk of endometritis (95% CI 15.4, 29.1). Even without trial of labor, women after primary cesarean delivery were 10.3 times more likely to develop endometritis (95% CI 5.9, 17.9) than after spontaneous vaginal delivery. The risk of transfusion was highest in women delivered by primary cesarean after labor, 4.2 times higher (95% CI 1.8, 10.1) than spontaneous vaginal delivery. The risk of pneumonia was 9.3 times higher (95% CI 3.4, 25.6) after repeat cesarean delivery with labor. Deep venous thromboses occurred in 15 (0.1%) after spontaneous vaginal delivery, 2 (0.04%) after operative vaginal delivery, and 12 (0.2%) after cesarean delivery.CONCLUSION: Compared with spontaneous vaginal delivery, cesarean delivery is associated with increased risks of endometritis, the need for transfusion, and pneumonia; however, these rates are lower than reported previously. ((C) 2004 by The American College of Obstetricians and Gynecologists.).