Schindl Monika, Birner Peter, Reingrabner Michaela, Joura ElmarA, Husslein Peter, Langer Martin
Department of Obstetrics and Gynecology, University of Vienna, Austria.
Acta Obstet Gynecol Scand. 2003 Sep;82(9):834-40. doi: 10.1034/j.1600-0412.2003.00194.x.
To investigate birth experience and medical outcome in women with elective cesarean section (CS) compared with women with intended vaginal delivery.
A total of 1050 pregnant women were included in this prospective trial. Psychological factors, pain levels and birth experience were investigated using a self-designed questionnaire and three established psychological tests in gestational week 38, and 3 days and 4 months postpartum. In addition, medical data were evaluated from the records.
Out of 903 women with planned vaginal birth, in 484 women (53.6%) minimal perineal surgery had to be performed after birth, 41 women (4.5%) had vacuum deliveries, and in 93 cases (10.3%) emergency CS had to be performed. In the 147 elective CS (103 based on medical and 44 on psychological factors), a significantly lower rate of maternal and fetal complications was observed when compared with vaginal birth (5.4% vs. 19.3%; p < 0.0001). Birth experience (Salmon test) was significantly better in elective CS compared with vaginal delivery, but worse in women with emergency CS and worst in those with vacuum delivery. We found that 83.5% of women with vaginal delivery would choose the same mode of birth again, 74.3% of women with CS on demand, and 66% of women with medically necessary CS. Only 30.1% of women with emergency CS wanted to receive CS at the next birth.
Elective CS is a safe and psychologically well tolerated procedure. The results are comparable with uncomplicated vaginal delivery and far superior to secondary intervention such as vacuum delivery or emergency CS.
比较择期剖宫产（CS）妇女与计划阴道分娩妇女的分娩经历和医学结局。
本前瞻性试验共纳入1050名孕妇。在孕38周、产后3天和4个月时，使用自行设计的问卷和三项既定的心理测试调查心理因素、疼痛程度和分娩经历。此外，从记录中评估医学数据。
在903名计划阴道分娩的妇女中，484名妇女（53.6%）产后必须进行最小限度的会阴手术，41名妇女（4.5%）进行了真空吸引分娩，93例（10.3%）必须进行急诊剖宫产。在147例择期剖宫产中（103例基于医学因素，44例基于心理因素），与阴道分娩相比，母婴并发症发生率显著较低（5.4%对19.3%；p<0.0001）。与阴道分娩相比，择期剖宫产的分娩经历（Salmon测试）明显更好，但急诊剖宫产妇女的分娩经历较差，真空吸引分娩妇女的分娩经历最差。我们发现，83.5%的阴道分娩妇女会再次选择相同的分娩方式，74.3%的按需剖宫产妇女会再次选择剖宫产，66%的有医学指征剖宫产妇女会再次选择剖宫产。只有30.1%的急诊剖宫产妇女希望下次分娩时接受剖宫产。
择期剖宫产是一种安全且心理耐受性良好的手术。结果与无并发症的阴道分娩相当，远优于真空吸引分娩或急诊剖宫产等二次干预。
