Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population
Influence of the mode of delivery on maternal and neonatal outcomes: a comparison between elective cesarean section and planned vaginal delivery in a low-risk obstetric population
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DOI：
10.1007/s00404-010-1525-y
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发表时间：
2011-06-01
影响因子：
2.6
通讯作者：
Bodner-Adler, Barbara
中科院分区：
文献类型：
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作者：
Bodner, Klaus;Wierrani, Franz;Bodner-Adler, Barbara
本研究的目的是比较择期剖宫产与计划阴道分娩的产妇和新生儿的发病率。共有178名择期剖宫产的妇女与下一个产次和年龄匹配的自然分娩妇女进行了比较。我们的分析仅限于低风险产科妇女的样本。产妇和新生儿的结果是主要的结果变量。产妇发病率结果变量包括伤口感染、创伤、产后发热发病率和大量失血（> 500 ml）。观察新生儿的Apgar评分、脐带pH值及新生儿感染情况，剖宫产组的产褥期发热发生率（n = 46 vs. 14，p = 0.0001）和伤口感染发生率（n = 16 vs. 2，p = 0.0001）明显高于剖宫产组。此外，剖腹产组中失血量> 500 ml的频率是剖腹产组的两倍多（n = 22 vs. 10，p = 0.03），产后血红蛋白水平无显着降低（10.4 vs. 11.2 g/dL，p > 0.05）。铁补充剂的使用显著增加（n = 146 vs. 122，p = 0.002），镇痛药（n = 168 vs. 60，p = 0.0001）和抗生素（n = 48 vs. 18，p = 0.0001）可在产褥期发现，择期剖宫产的住院时间延长（6.8 vs 3.5天，p = 0.0001）。此外，母乳喂养问题在该组中发生得更频繁（n = 18 vs. 4，p = 0.002）。两组新生儿并发症发生率均较低，差异无统计学意义（p > 0.05）。择期剖宫产增加的产妇发病率包括产后发热、伤口感染以及产后母乳喂养问题。应向妇女提供关于这些并发症风险增加的充分咨询。
The aim of the study was to compare the maternal and neonatal morbidity associated with elective cesarean sections with planned vaginal delivery.A total of 178 women with elective cesarean section were compared with the next parity- and age-matched women presenting in spontaneous labor. Our analysis was restricted to a sample of low-risk obstetrical women. Maternal and neonatal outcomes were the main outcome variables of interest. Maternal morbidity outcome variables included wound infection, trauma, puerperal febrile morbidity and significant blood loss (> 500 ml). Neonatal outcomes were captured by Apgar scores, cord pH as well as the occurrence of neonatal infections.A significantly higher rate of puerperal febrile morbidity (n = 46 vs. 14, p = 0.0001) and wound infections (n = 16 vs. 2, p = 0.0001) could be detected in the elective cesarean section group. Additionally, a significant blood loss > 500 ml was more than twice as frequent in the cesarean section group (n = 22 vs. 10, p = 0.03) with non-significant lower postpartum hemoglobin levels being observed (10.4 vs. 11.2 g/dL, p > 0.05). A significant increase for the use of iron supplementation (n = 146 vs. 122, p = 0.002), analgesics (n = 168 vs. 60, p = 0.0001) and antibiotics (n = 48 vs. 18, p = 0.0001) could be found in the puerperal period and hospital admission was prolonged in elective cesarean section (6.8 vs. 3.5 days, p = 0.0001). Additionally, problems in breastfeeding occurred more frequently in this group (n = 18 vs. 4, p = 0.002). Neonatal complications were generally low in both the groups with no significant differences being observed (p > 0.05).The increased maternal morbidity in elective cesarean section included puerperal febrile morbidity, wound infections as well as breastfeeding problems in the postpartum period. Women should be sufficiently counseled regarding the increased risk of these complications.