Hemminki Elina, Shelley Julia, Gissler Mika
National Research and Development Centre for Welfare and Health, Health Services Research, Helsinki, Finland.
Am J Obstet Gynecol. 2005 Jul;193(1):169-77. doi: 10.1016/j.ajog.2004.11.007.
The purpose of this study was to investigate the effects of delivery on problems in subsequent births.
This was a cohort study that used register data for 73,104 mothers who had their first birth from 1987 to 1989 and subsequent births from 1987 to1998. Three analyses were performed: (1) examination of second births by mode of delivery in the first birth, with adjustment for confounders, (2) same parameter, with exclusion of women with persistent problems, and (3) examination of third births for women with a first birth vaginal delivery.
More complications and poorer infant outcome were found at later births when the first or second birth was by cesarean delivery than after a first spontaneous vaginal delivery, even when women with persistent problems were excluded. Women with instrument first births had a similar rate of complications in the second birth to women with spontaneous vaginal births, but some infant outcomes were poorer.
Problems that are subsequent to cesarean delivery are unlikely to be explained entirely by indications for cesarean delivery.
本研究旨在调查分娩对后续分娩问题的影响。
这是一项队列研究，使用了1987年至1989年首次分娩以及1987年至1998年后续分娩的73104名母亲的登记数据。进行了三项分析：（1）根据首次分娩的分娩方式对第二次分娩进行检查，并对混杂因素进行调整；（2）相同参数，但排除有持续性问题的女性；（3）对首次阴道分娩的女性的第三次分娩进行检查。
即使排除了有持续性问题的女性，当首次或第二次分娩为剖宫产时，后续分娩时发现的并发症更多，婴儿结局更差。首次分娩使用器械助产的女性第二次分娩时的并发症发生率与自然阴道分娩的女性相似，但一些婴儿结局较差。
剖宫产术后出现的问题不太可能完全由剖宫产指征来解释。
