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孕产妇并发症负担与剖腹产分娩率之间的关联 在无卵性,终身,单子,顶部怀孕中
Cara S Wetcher1, Rachel L Kirshenbaum1, Alejandro Alvarez2
1Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
JAMA network open
|October 19, 2023
概括
孕产妇的健康状况显著增加了无胎,满期,单胎,顶部 (NTSV) 怀孕的剖腹产风险. 种族和民族差异仍然存在,这表明除了并发症负担之外的因素影响了分娩结果.
科学领域:
- 产科和妇科 产科和妇科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 无胎,满期,单胎,顶胎 (NTSV) 怀孕的剖腹产分娩率是产科质量指标的关键指标.
- 关于先前存在的疾病和母亲的并发症负担如何影响分娩模式的数据有限,特别是在种族和种族群体之间.
- 了解这些因素对于解决NTSV剖腹产分娩率差异至关重要.
研究的目的:
- 检查产科并发症指数 (OB-CMI) 评分和NTSV怀孕中剖腹产之间的关联.
- 在对相关共变量进行调整后,评估交付方式中的种族和民族差异.
主要方法:
- 一项横截面研究分析了2019年1月至2021年12月期间纽约7家医院30253例NTSV怀孕的数据.
- 产科并发症指数 (OB-CMI) 分数被用于量化先前存在的疾病.
- 对种族/种族,保险和语言进行调整的后勤回归模型,以评估剖腹产风险.
主要成果:
- 整体NTSV剖腹产分娩率为28.5%,为28.5%.
- 剖腹产分娩风险随着OB-CMI得分的提高而显著增加;得分为4+的患者的剖腹产分娩几率是剖腹产分娩的3倍以上 (aOR,3.14).
- 种族和种族差异很明显,与非西班牙裔白人患者相比,非西班牙裔黑人患者的风险最高 (aOR,1.43).
结论:
- 通过OB-CMI得分测量的较高的孕产妇并发症负担,与NTSV怀孕中的剖腹产有关.
- 在剖腹产分娩率中观察到的种族和民族差异并不能完全由先前存在的条件的差异来解释.
- 未测量的临床或非临床因素可能导致剖腹产差异,需要进一步调查.
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