上一次剖腹产后死产的风险:瑞典全国的队列研究
Sukainah Y Al Khalaf1, Alexander E P Heazell2, Marius Kublickas3
1School of Public Health, University College Cork, Cork, Ireland.
BJOG : an international journal of obstetrics and gynaecology
|January 29, 2024
概括
以前的剖腹产 (CD) 增加了在随后的怀孕中死产的风险. 产前CD的风险更高,但剖腹产后阴道分娩 (VBAC) 与重复CD相比,不会增加产内死产的风险.
科学领域:
- 产科和妇科 产科和妇科
- 围产期流行病学 围产期流行病学
- 生殖健康 生殖健康
背景情况:
- 以前的剖腹产 (CD) 是一种常见的产科手术.
- 了解以前的CD对后续怀孕结果的影响,特别是死产风险,对于临床决策至关重要.
研究的目的:
- 调查之前的剖腹产 (CD) 与随后怀孕中死产风险之间的关联.
- 为了比较经过剖腹产后阴道分娩的女性 (VBAC) 与重复CD的死亡出生风险.
主要方法:
- 使用瑞典医学出生登记册 (1982-2012) 进行基于人口的队列研究.
- 分析包括了第一次和第二次单独怀孕的妇女.
- 多变量逻辑回归模型被用来估计调整的赔率比率 (aOR) 和95%置信区间 (CI).
主要成果:
- 与之前的阴道分娩 (aOR 1.37;95% CI 1.23-1.52) 相比,以前患有CD的妇女在第二次怀孕中死产的几率增加了37%.
- 在产前CD组中,产内死胎的几率明显高于产前CD组 (aOR2.72;95% CI 1.51-4.91).
- 与重复CD相比,VBAC没有观察到产后死胎的几率增加 (aOR 0.99;95% CI 0.48-2.06).
结论:
- 剖腹产与随后死产的风险增加有关,特别是在分娩前进行时.
- 之前的CD和死胎之间的关联不仅仅是通过产后事件 (如窒息或子宫破裂) 来解释的.
- 研究结果支持关于分娩方式的知情决策,特别是在选择性剖腹产方面.
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