Deulofeut Richard, Sola Augusto, Lee Ben, Buchter Susie, Rahman Mostafizur, Rogido Marta
Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia, USA.
Obstet Gynecol. 2005 Mar;105(3):525-31. doi: 10.1097/01.AOG.0000154156.51578.50.
To evaluate whether mode of delivery is a predictor of poor short-term outcome at different birth weight categories in very low birth weight infants.
This study examined a cohort of infants weighing less than 1,251 g born at 2 perinatal centers from January 1, 2000, to December 31, 2003. Outborn infants or those with major anomalies were excluded from the study. Outcome variables included death, severe intraventricular hemorrhage, periventricular leukomalacia (PVL), and combined poor short-term outcomes (death, severe intraventricular hemorrhage, and PVL).
Of the 397 infants who met enrollment criteria, 44% were born vaginally and 56% by cesarean delivery. The proportion of multiparous, breech presentation and prolonged rupture of membranes was significantly different between groups. For infants weighing less than 751 g, the risks of severe intraventricular hemorrhage (41% versus 22%; odds ratio [OR] 2.79, 95% confidence interval [CI] 1.08-7.72) and combined poor short-term outcome (67% versus 41%; OR 2.95, 95% CI 1.25-6.95) were significantly higher if delivered vaginally. Among survivors weighing less than 751 g, the risk of severe intraventricular hemorrhage was higher among those delivered vaginally (24% versus 9%; OR 8.18, 95% CI 1.58-42.20). In infants less 1,251 g who survived, vaginal delivery had a strong association with PVL (5% versus 1%; OR 11.53, 95% CI 1.66-125).
In infants less than 1,251 g who survived to discharge, vaginal delivery is associated with higher risk for PVL. Furthermore, in infants less than 751 g, vaginal delivery is a predictor for severe intraventricular hemorrhage and combined poor short-term outcome. The negative impact of vaginal delivery mode decreases as birth weight category increases.
评估分娩方式是否为极低出生体重儿不同出生体重类别短期预后不良的预测因素。
本研究对2000年1月1日至2003年12月31日在2家围产期中心出生的体重小于1251g的婴儿队列进行了研究。外院出生的婴儿或有严重畸形的婴儿被排除在研究之外。结局变量包括死亡、重度脑室内出血、脑室周围白质软化（PVL）以及综合短期不良结局（死亡、重度脑室内出血和PVL）。
在符合纳入标准的397例婴儿中，44%为阴道分娩，56%为剖宫产。两组间经产妇、臀位和胎膜早破时间延长的比例有显著差异。对于体重小于751g的婴儿，阴道分娩时重度脑室内出血的风险（41%对22%；优势比[OR]2.79，95%置信区间[CI]1.08 - 7.72）和综合短期不良结局的风险（67%对41%；OR 2.95，95%CI 1.25 - 6.95）显著更高。在体重小于751g的存活婴儿中，阴道分娩者重度脑室内出血的风险更高（24%对9%；OR 8.18，95%CI 1.58 - 42.20）。在体重小于1251g的存活婴儿中，阴道分娩与PVL密切相关（5%对1%；OR 11.53，95%CI 1.66 - 125）。
在存活至出院的体重小于1251g的婴儿中，阴道分娩与PVL的较高风险相关。此外，在体重小于751g的婴儿中，阴道分娩是重度脑室内出血和综合短期不良结局的预测因素。随着出生体重类别的增加，阴道分娩方式的负面影响减小。
