Effect of mode of delivery in nulliparous women on neonatal intracranial injury.
Effect of mode of delivery in nulliparous women on neonatal intracranial injury.
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DOI：
10.1056/nejm199912023412301
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发表时间：
1999-12-02
影响因子：
158.5
通讯作者：
Gilbert, WM
中科院分区：
文献类型：
--
作者：
Towner, D;Castro, MA;Gilbert, WM
背景：采用真空抽吸或其他手术技术分娩的婴儿可能比自然分娩的婴儿更容易遭受重大伤害，但风险的程度尚不清楚。方法：从加利福尼亚数据库中，我们确定了583340名1992年至1994年间由未分娩妇女所生的活产单胎婴儿，体重在2500至4000克之间。三分之一的婴儿是通过手术分娩的。我们评估了分娩方式与婴儿发病率之间的关系。结果：860例真空抽吸分娩1例颅内出血，664例使用产钳分娩1例，907例剖宫产分娩1例，2750例剖宫产分娩1例，1900例自然分娩1例。与自然分娩的婴儿相比，真空抽吸分娩的婴儿硬膜下出血或脑出血的发生率明显更高（优势比，2.7；95%可信区间，1.9至3.9），与使用产钳分娩的婴儿（优势比，3.4；95%可信区间，1.9至5.9）或剖宫产分娩的婴儿(优势比，2.5；95%可信区间，1.8 - 3.4)，但与使用产钳相关的硬膜下出血或脑出血发生率与使用产钳相关的发生率无显著差异（与真空抽吸相比的优势比为1.2；95%可信区间，0.7 - 2.2）或分娩时剖宫产（优势比为0.9；95%可信区间，0.6 - 1.4）。结论：产程中采用真空抽吸、产钳、剖宫产分娩的患儿颅内出血发生率高于自然分娩，但产前剖宫产患儿颅内出血发生率不高于自然分娩，提示颅内出血的共同危险因素为异常产程。[J] .中华医学杂志1999；31(1):1709- 1714。(C) 1999年，马萨诸塞州医学协会。
Background: Infants delivered by vacuum extraction or other operative techniques may be more likely to sustain major injuries than those delivered spontaneously, but the extent of the risk is unknown.Methods: From a California data base, we identified 583,340 live-born singleton infants born to nulliparous women between 1992 and 1994 and weighing between 2500 and 4000 g. One third of the infants were delivered by operative techniques. We evaluated the relation between the mode of delivery and morbidity in the infants.Results: Intracranial hemorrhage occurred in 1 of 860 infants delivered by vacuum extraction, 1 of 664 delivered with the use of forceps, 1 of 907 delivered by cesarean section during labor, 1 of 2750 delivered by cesarean section with no labor, and 1 of 1900 delivered spontaneously. As compared with the infants delivered spontaneously, those delivered by vacuum extraction had a significantly higher rate of subdural or cerebral hemorrhage (odds ratio, 2.7; 95 percent confidence interval, 1.9 to 3.9), as did the infants delivered with the use of forceps (odds ratio, 3.4; 95 percent confidence interval, 1.9 to 5.9) or cesarean section during labor (odds ratio, 2.5; 95 percent confidence interval, 1.8 to 3.4), but the rate of subdural or cerebral hemorrhage associated with vacuum extraction did not differ significantly from that associated with forceps use (odds ratio for the comparison with vacuum extraction, 1.2; 95 percent confidence interval, 0.7 to 2.2) or cesarean section during labor (odds ratio, 0.9; 95 percent confidence interval, 0.6 to 1.4).Conclusions: The rate of intracranial hemorrhage is higher among infants delivered by vacuum extraction, forceps, or cesarean section during labor than among infants delivered spontaneously, but the rate among infants delivered by cesarean section before labor is not higher, suggesting that the common risk factor for hemorrhage is abnormal labor. (N Engl J Med 1999;341:1709-14.) (C) 1999, Massachusetts Medical Society.