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加利福尼亚州单胎早产臀位分娩的阴道分娩与剖宫产:一项基于人群的研究。

Vaginal vs. cesarean delivery for preterm breech presentation of singleton infants in California: a population-based study.

作者信息

Robilio Peter A, Boe Nina M, Danielsen Beate, Gilbert William M

机构信息

Department of Obstetrics and Gynecology, University of California, Davis, and Health Information Solutions, Rocklin, California, USA.

出版信息

J Reprod Med. 2007 Jun;52(6):473-9.

Abstract

OBJECTIVE

To examine the morbidity and mortality associated with vaginal breech delivery (VBD) of premature, low-birth-weight (LBW) (< 2.5 kg) newborns as compared to delivery by cesarean section.

STUDY DESIGN

A retrospective cohort study of singleton, preterm (< 37 weeks), LBW, nonanomalous newborns in California (January 1, 1991-December 31, 1999) was performed. Neonatal morbidity and mortality by route of delivery were compared.

RESULTS

Overall, 14,417 LBW, preterm, breech newborns were delivered (14% vaginally and 86% by cesarean). There were 150,570 LBW, preterm, cephalic newborns, of whom 82% were delivered vaginally. VBD of LBW newborns in nulliparous women was associated with increased neonatal mortality in newborns weighing 500-1,000 g (OR 11.7; 95% CI 7.9, 17.2), 1,001-1,500 g (OR 17.0; 95% CI 6.8, 42.7), 1,501-2,000 g (OR 7.2; 95% CI 2.4, 21.4), and 2,001-2,500 g (OR 6.6; 95% CI 2.1, 21.2) as compared with breech delivery by cesarean in nulliparous women. Birth trauma was increased in VBD of newborns weighing 1,500-2,000 g (OR 3.8; 95% CI 1.4, 10.1) and 2,001-2,500 g (OR 4.5; 95% CI 2.6, 7.9) as compared to breech delivery by cesarean in nulliparous women. Birth asphyxia was increased in breech newborns weighing 2,001-2,500 g (OR 3.5; 95% CI 2.2, 5.6) delivered vaginally in nulliparous women as compared to cephalic vaginal deliveries.

CONCLUSION

VBD of the preterm, LBW newborn is associated with significantly increased neonatal mortality as compared to cesarean section at similar birth weights. Birth trauma (> 1,500 g) was greater with VBD as compared to breech delivery by cesarean, and asphyxia (> 2,000 g) was greater with VBD as compared to cephalic vaginal delivery, suggesting that cesarean delivery may be a safer route of delivery for preterm breech fetuses.

摘要

目的

与剖宫产相比,研究早产、低出生体重(LBW,<2.5kg)新生儿经阴道臀位分娩(VBD)的发病率和死亡率。

研究设计

对加利福尼亚州1991年1月1日至1999年12月31日的单胎、早产(<37周)、低出生体重、无畸形新生儿进行回顾性队列研究。比较不同分娩方式的新生儿发病率和死亡率。

结果

总体而言,共分娩了14417例低出生体重、早产、臀位新生儿(14%经阴道分娩,86%经剖宫产)。有150570例低出生体重、早产、头位新生儿,其中82%经阴道分娩。未产妇中,体重500 - 1000g(比值比[OR]11.7;95%置信区间[CI]7.9,17.2)、1001 - 1500g(OR 17.0;95% CI 6.8,42.7)、1501 - 2000g(OR 7.2;95% CI 2.4,21.4)和2001 - 2500g(OR 6.6;95% CI 2.1,21.2)的低出生体重新生儿经阴道臀位分娩与经剖宫产臀位分娩相比,新生儿死亡率增加。与未产妇经剖宫产臀位分娩相比,体重1500 - 2000g(OR 3.8;95% CI 1.4,10.1)和2001 - 2500g(OR 4.5;95% CI 2.6,7.9)的新生儿经阴道臀位分娩时出生创伤增加。与头位经阴道分娩相比,未产妇中体重2001 - 2500g经阴道分娩的臀位新生儿出生窒息增加(OR 3.5;95% CI 2.2,5.6)。

结论

与相同出生体重下的剖宫产相比,早产、低出生体重新生儿经阴道臀位分娩的新生儿死亡率显著增加。与经剖宫产臀位分娩相比,经阴道臀位分娩时出生创伤(>1500g)更大,与头位经阴道分娩相比,经阴道臀位分娩时窒息(>2000g)更严重,这表明剖宫产可能是早产臀位胎儿更安全的分娩方式。

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