Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany
Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany
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DOI：
10.1186/s12884-018-2145-y
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发表时间：
2019-01-03
影响因子：
3.1
通讯作者：
Razum, Oliver
中科院分区：
文献类型：
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作者：
Breckenkamp, Juergen;Laecke, Eileen Marie;Razum, Oliver
研究背景：在分娩早期进入产房的妇女中，剖腹产率高于分娩后期。在德国的一项研究中，土耳其和黎巴嫩移民妇女的粗剖宫产率低于非移民妇女。我们评估这些移民妇女是否承认在后期阶段的劳动力，如果是这样的话，这是否可以解释其较低的剖腹产率。MethodsWe招募了1413初产妇的妇女与顶点妊娠，单胎分娩，37+周的妊娠，不包括择期剖腹产分娩，在三个柏林产科医院。我们应用二元逻辑回归调整社会和产科因素，并标准化系数排名预测来自回归model.ResultsAt入院分娩病房的时候，土耳其移民妇女的比例较小，在劳动力的活跃阶段（宫颈扩张：4+厘米），黎巴嫩裔和非移民妇女相比。土耳其裔和黎巴嫩裔妇女的剖腹产率（15.8%和13.9%）低于非移民妇女（23.9%）。Logistic回归分析显示，宫颈扩张程度越高，剖宫产率越低（OR：0.76，95%CI：0.70-0.82）。此外，较高的母亲年龄（OR：1.06，95%CI：1.04-1.09），应用催产剂（OR：0.55，95%CI：0.42-0.72）和肥胖（OR：2.25，95%CI：1.51-3.34）与结局相关。预测因素的排名表明，宫颈扩张是最相关的预测来自回归model.ConclusionsAdvanced宫颈扩张在入院分娩病房的时间并不能解释较低的紧急剖宫产率在土耳其和黎巴嫩的移民妇女，尽管事实上，这是最强的预测因素，在这项研究中确定的紧急剖宫产。
BackgroundCesarean rates are higher in women admitted to labor ward during early stages rather than at later stages of labor. In a study in Germany, crude cesarean rates among Turkish and Lebanese immigrant women were low compared to non-immigrant women. We evaluated whether these immigrant women were admitted during later stages of labor, and if so, whether this explains their lower cesarean rates.MethodsWe enrolled 1413 nulliparous women with vertex pregnancies, singleton birth, and 37+ week of gestation, excluding elective cesarean deliveries, in three Berlin obstetric hospitals. We applied binary logistic regression to adjust for social and obstetric factors; and standardized coefficients to rank predictors derived from the regression model.ResultsAt the time of admission to labor ward, a smaller proportion of Turkish migrant women was in the active phase of labor (cervical dilation: 4+ cm), compared to women of Lebanese origin and non-immigrant women. Rates of cesarean deliveries were lower in women of Turkish and Lebanese origin (15.8 and 13.9%) than in non-immigrant women (23.9%). In the logistic regression analysis, more advanced cervical dilatation was inversely associated with the outcome cesarean delivery (OR: 0.76, 95%CI: 0.70-0.82). In addition, higher maternal age (OR: 1.06, 95%CI: 1.04-1.09), application of oxytocic agents (OR: 0.55, 95%CI: 0.42-0.72), and obesity (OR: 2.25, 95%CI: 1.51-3.34) were associated with the outcome. Ranking of predictors indicate that cervical dilatation is the most relevant predictor derived from the regression model.ConclusionsAdvanced cervical dilatation at the time of admission to labor ward does not explain lower emergency cesarean delivery rates in Turkish and Lebanese migrant women, despite the fact that this is the strongest among the predictors for emergency cesarean delivery identified in this study.