Mode of delivery and infant respiratory morbidity among infants born to HIV-1-infected women.
Mode of delivery and infant respiratory morbidity among infants born to HIV-1-infected women.
复制标题
HIV-1 感染妇女所生婴儿的分娩方式和婴儿呼吸道发病率。
DOI：
10.1097/aog.0b013e3181e8f38a
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发表时间：
2010
影响因子：
7.2
通讯作者：
InternationalMaternalPediatricAdolescentAIDSClinicalTrialsGroup(IMPAACT)Protocol1025Stud
中科院分区：
文献类型：
--
作者：
Livingston,ElizabethG;Huo,Yanling;Patel,Kunjal;Brogly,SusanB;Tuomala,Ruth;Scott,GwendolynB;Bardeguez,Arlene;Stek,Alice;Read,JenniferS;InternationalMaternalPediatricAdolescentAIDSClinicalTrialsGroup(IMPAACT)Protocol1025Stud
OBJECTIVE:To estimate risk of infant respiratory morbidity associated with cesarean delivery before labor and ruptured membranes among HIV-1-infected women.METHODS:In a prospective cohort study of HIV-1-infected women and their infants, mode of delivery was determined by clinicians at the participating sites. For this analysis,“elective cesarean delivery” was defined as any cesarean delivery, regardless of gestational age, without labor and with duration of ruptured membranes of less than 5 minutes. Nonelective cesarean deliveries were those performed after the onset of labor, rupture of membranes, or both. Vaginal delivery included normal spontaneous and instrument deliveries. Associations between mode of delivery and infant respiratory morbidity were assessed using χ 2 or Fisher's exact test. Adjusted odds of respiratory distress syndrome by delivery mode were assessed using multivariable logistic regression.RESULTS:Among 1,194 mother-infant pairs, there were significant differences according to mode of delivery in median gestational age (weeks) at delivery (vaginal, n= 566, median= 38.8; nonelective cesarean, n= 216, median= 38.0; and elective cesarean, n= 412, median 38.1; P<. 001) and incidence of respiratory distress syndrome (vaginal, n= 9, 1.6%, reference; nonelective cesarean, n= 16, 7.4%; elective cesarean, n= 18; 4.4%;(P<. 001). In analyses adjusted for gestational age and birth weight, mode of delivery was not statistically significantly associated with infant respiratory distress syndrome (P=. 10), although a trend toward an increased risk of respiratory distress syndrome among infants delivered by cesarean was suggested (nonelective cesarean adjusted odds ratio [OR] 2.32, 95% confidence interval [CI] 0.95-5.67; elective cesarean OR 2.56, 95% CI 1.01-6.48).CONCLUSION:Respiratory distress syndrome rates associated with elective cesarean delivery among HIV-1-infected women are low, comparable with published rates among uninfected women. There is minimal neonatal respiratory morbidity risk in near-term infants born by elective cesarean delivery to HIV-1-infected women.LEVEL OF EVIDENCE:IICurrent cesarean delivery use in the setting of HIV-1 infection does not place infants at excessive risk of respiratory morbidity.
