Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08
Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08
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DOI：
10.1016/s0140-6736(09)61870-5
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发表时间：
2010-02-06
期刊：
影响因子：
168.9
通讯作者：
Villar, Jose
中科院分区：
文献类型：
--
作者：
Lumbiganon, Pisake;Laopaiboon, Malinee;Villar, Jose
背景：世界范围内剖腹产率的上升一直令人担忧。本文报道了世界卫生组织全球调查的第三阶段，其目的是估计不同分娩方法的比率，并检查2004-05年非洲和拉丁美洲以及2007-08年亚洲选定机构中不同分娩方法与孕产妇和围产儿结局的关系。方法9个国家参加了亚洲全球调查：柬埔寨、中国、印度、日本、尼泊尔、菲律宾、斯里兰卡、泰国和越南。在每个国家，首都和另外两个地区或省份都是随机选择的。我们研究了在每年预期分娩次数不超过6000次的机构中，在3个月内入院分娩的所有妇女，以及在超过6000次分娩的机构中，在2个月内获准分娩的所有妇女。我们为各机构收集数据，以获得保健设施及其产科护理资源的详细说明。我们从妇女的医疗记录中获得数据，以总结产科和围产期事件。结果我们获得了在122个招募机构(97%的覆盖率)报告的112152次分娩中的109101的数据，并分析了107950次分娩。剖宫产率27.3%(n=29428)，手术阴道分娩率3.2%(n=3465)。产妇死亡和发病率指数(至少有一项为孕产妇死亡、住进重症监护病房、输血、子宫切除或髂内动脉结扎)增加了手术阴道分娩(调整后的优势比2.1，95%CI 1.7~2.6)和所有类型的剖宫产(产前无指征2.7，1.4~5.5；产前有指征10.6，9.3~12.0；分娩无指征14.2，9.8~20.7；临产时)。指示14.5、13.2-16.0)。对于臀位，剖宫产，无论是产前(0.2，0.1-0.3)或产中(0.3，0.2-0.4)，都与改善围产儿结局有关，但也与在新生儿ICU停留的风险增加(分别为2.0，1.1-3.6；2.1，1.2-3.7)有关。为了改善母亲和围产儿的结局，只有在有医学指征的情况下才应进行剖腹产。
Background There has been concern about rising rates of Caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08.Methods Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. in each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events.Findings We obtained data for 109101 of 112152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of Caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of Caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum. with indication 14.5, 13.2-16.0). For breech presentation, Caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively).Interpretation To improve maternal and perinatal outcomes, Caesarean section should be done only when there is a medical indication.