Atrash H K, Hogue C J, Becerra J W
Division of Reproductive Health, Centers for Disease Control, Atlanta, GA 30333.
Am J Prev Med. 1991 Jul-Aug;7(4):227-31.
The role of cesarean section in improving infant survival has not been clearly documented. We calculated birthweight- and race-specific infant, neonatal, and postneonatal mortality risks by method of delivery for single- and multiple-delivery infants, using data from 14 states, reported to the Centers for Disease Control through the 1980 National Infant Mortality Surveillance project. For single-delivery infants, the risk of death for infants delivered by cesarean section was 1.6 times higher than for infants delivered vaginally among blacks and 1.2 times higher among whites. The risk was 1.7 times higher during the neonatal period and 1.2 times higher during the postneonatal period. For infants with birthweight less than 1,000 grams, the risk of death was lower when infants were delivered by cesarean section. The risk of death among multiple-delivery infants born by cesarean section was significantly lower than for those born vaginally. This analysis demonstrates that, unlike other birthweight categories, infants with a very low birthweight may have better outcomes if delivered by cesarean section. However, we cannot recommend the routine use of cesarean section for delivering very low birthweight infants. Further studies are needed to determine survival of such infants after controlling for maternal and infant conditions that prompted delivery by cesarean section.
剖宫产在提高婴儿存活率方面的作用尚未得到明确证实。我们利用1980年全国婴儿死亡率监测项目中向疾病控制中心报告的来自14个州的数据，按分娩方式计算了单胎和多胎婴儿的出生体重及种族特异性婴儿、新生儿和新生儿后期的死亡风险。对于单胎婴儿，剖宫产分娩的婴儿死亡风险在黑人中比阴道分娩的婴儿高1.6倍，在白人中高1.2倍。在新生儿期风险高1.7倍，在新生儿后期高1.2倍。对于出生体重低于1000克的婴儿，剖宫产分娩时死亡风险较低。剖宫产出生的多胎婴儿的死亡风险显著低于阴道分娩的婴儿。该分析表明，与其他出生体重类别不同，极低出生体重的婴儿若通过剖宫产分娩可能会有更好的结局。然而，我们不建议常规使用剖宫产来分娩极低出生体重的婴儿。需要进一步研究以确定在控制了促使剖宫产分娩的母婴状况后此类婴儿的存活率。
