Cesarean delivery and subsequent pregnancies
Cesarean delivery and subsequent pregnancies
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DOI：
10.1097/aog.0b013e3181744110
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发表时间：
2008-06-01
影响因子：
7.2
通讯作者：
Irgens, Lorentz M.
中科院分区：
文献类型：
--
作者：
Daltveit, Anne Kjersti;Tollanes, Mette Christophersen;Irgens, Lorentz M.
目的：评估剖宫产对后续妊娠结局的可能影响。使用历史队列设计，我们分析了637,497名有两次或两次以上单胎的妇女的第一胎和第二胎，以及在人口中登记有三个或三个以上单胎的妇女中的第三胎，1967 ~ 2003年挪威医学出生登记处数据。与第一胎阴道分娩相比，第一胎剖宫产，第二胎，先兆子痫的风险增加（比值比[OR] 2.9和相应的95%置信区间[CI] 2.8-3.1），小于胎龄（OR 1.5; CI 1.4-1.5）、前置胎盘（OR 1.5; CI 1.3-1.8）、胎盘植入（OR 1.9; CI 1.3-2.8）、胎盘脱垂（OR 2.0; CI 1.8-2.2）和子宫破裂（OR 37.4; CI 24.9-56.2）。在排除首次分娩时实际并发症的女性后，相应的OR通常较低：分别为1.7（CI 1.6-1.8）、1.3（CI 1.3-1.4）、1.4（CI 1.2-1.7）、1.9（CI 1.3-2.8）、1.7（CI 1.6-1.9）和37.2（CI 24.7-55.9）。预防一例病例所需的剖腹产数量相应减少分别为114、56、1,140、3,706、300和461例。在第三次分娩中，再次剖宫产后的OR与一次剖宫产后的OR相似或更低;此外，排除既往妊娠中有实际结果的女性往往会降低OR。剖腹产与随后怀孕并发症的风险增加有关，但在排除了以前分娩时有实际并发症的妇女后，超额风险降低了。为了减少剖宫产对后续妊娠的影响，重要的是要考虑产科史。
OBJECTIVE: To assess possible effects of a cesarean delivery on outcome in subsequent pregnancies.METHODS: Using an historical cohort design, we analyzed 637,497 first and second births among women with two or more single births and 242,812 first, second, and third births among women with three or more single births registered in the population-based Medical Birth Registry of Norway between 1967 and 2003.RESULTS: Compared with a vaginal delivery at first birth, a cesarean delivery at first birth was followed, in a second pregnancy, by increased risks of preeclampsia (odds ratio [OR] 2.9 and corresponding 95% confidence interval [CI] 2.8-3.1), small for gestational age (OR 1.5; CI 1.4-1.5), placenta previa (OR 1.5; Cl 1.3-1.8, placenta accreta (OR 1.9; CI 1.3-2.8), placental abruption (OR 2.0; Cl 1.8-2.2), and uterine rupture (OR 37.4; Cl 24.9-56.2). After excluding women with the actual complication at first birth, the corresponding ORs were, in general, lower: 1.7 (CI 1.6-1.8), 1.3 (CI 1.3-1.4), 1.4 (CI 1.2-1.7), 1.9 (CI 1.3-2.8), 1.7 (CI 1.6-1.9), and 37.2 (CI 24.7-55.9), respectively. Corresponding reduction in numbers of cesarean deliveries needed to prevent one case were 114, 56, 1,140, 3,706, 300, and 461. In third births, ORs after repeat cesarean delivery were similar to or lower than the ORs after one cesarean delivery; also here, the exclusion of women with the actual outcome in any of their previous pregnancies tended to reduce the ORs.CONCLUSION: Cesarean delivery was associated with an increased risk of complications in a subsequent pregnancy, but excess risks were reduced after excluding women with the actual complication in any of their previous births. To obtain less biased effects of cesarean delivery on subsequent pregnancies, it is important to account for obstetric history.