在出生体重非常低的婴儿中,剖腹产率的增加. 对结果的影响
M H Malloy1, G G Rhoads, W Schramm
1Prevention Research Program, National Institute of Child Health and Human Development, Bethesda, Md 20892.
JAMA
|September 15, 1989
概括
对于出生时体重非常低的婴儿,剖腹产显著增加,但没有改善整体存活率. 最小婴儿的早期死亡被晚期死亡所抵消,这表明增加剖腹产的好处很小.
科学领域:
- 产周医学 产周医学
- 新生儿科学 新生儿科学
- 产科 产科 产科 产科 产科
背景情况:
- 1980年至1984年间,婴儿出生体重非常低 (500-1499克) 的剖腹产率显著上升.
- 在此期间,其他婴儿体重组的剖腹产率也增加了.
研究的目的:
- 调查剖腹产使用增加对出生体重非常低的婴儿的存活率的影响.
- 确定剖腹产是否为500-749克体重的婴儿提供生存益处.
主要方法:
- 从密苏里州 (1980-1984) 的出生和死亡证明链接的分析.
- 剖腹产和阴道分娩之间的第一天死亡率对出生时体重非常低的婴儿进行比较.
- 对诸如妊娠年龄和其他潜在混因素等因素进行统计调整.
主要成果:
- 剖腹产组的第一天死亡率 (10%) 低于非常低出生体重婴儿的阴道组 (22%).
- 这种差异主要是由500-740克的婴儿驱动的 (33%对59%的死亡率).
- 然而,这种早期生存优势被随后一周死亡人数的增加所抵消,导致第一周生存率没有显著差异 (几率比率为0.85).
结论:
- 在研究期间,对于出生体重非常低的婴儿来说,剖腹产的急剧增加几乎没有证据表明改善了整体存活率.
- 在独立于母亲或胎儿痛苦的情况下,对于这些脆弱的婴儿增加剖腹产的使用没有明确的理由.
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