Hansen Anne Kirkeby, Wisborg Kirsten, Uldbjerg Niels, Henriksen Tine Brink
Perinatal Epidemiology Research Unit, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark.
BMJ. 2008 Jan 12;336(7635):85-7. doi: 10.1136/bmj.39405.539282.BE. Epub 2007 Dec 11.
To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections.
Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark.
Obstetric department and neonatal department of a university hospital in Denmark.
All liveborn babies without malformations, with gestational ages between 37 and 41 weeks, and delivered between 1 January 1998 and 31 December 2006 (34 458 babies).
Respiratory morbidity (transitory tachypnoea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn) and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation).
2687 infants were delivered by elective caesarean section. Compared with newborns intended for vaginal delivery, an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 weeks' gestation (odds ratio 3.9, 95% confidence interval 2.4 to 6.5), 38 weeks' gestation (3.0, 2.1 to 4.3), and 39 weeks' gestation (1.9, 1.2 to 3.0). The increased risks of serious respiratory morbidity showed the same pattern but with higher odds ratios: a fivefold increase was found at 37 weeks (5.0, 1.6 to16.0). These results remained essentially unchanged after exclusion of pregnancies complicated by diabetes, pre-eclampsia, and intrauterine growth retardation, or by breech presentation.
Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity. The relative risk increased with decreasing gestational age.
探讨择期剖宫产与新生儿呼吸疾病之间的关联以及择期剖宫产时机的重要性。
采用队列研究，前瞻性收集丹麦奥胡斯出生队列的数据。
丹麦一家大学医院的产科和新生儿科。
所有无畸形、孕周在37至41周之间且于1998年1月1日至2006年12月31日期间出生的活产婴儿（共34458名婴儿）。
呼吸疾病（新生儿暂时性呼吸急促、呼吸窘迫综合征、新生儿持续性肺动脉高压）和严重呼吸疾病（吸氧超过两天、经鼻持续气道正压通气或需要机械通气）。
2687名婴儿通过择期剖宫产出生。与计划经阴道分娩的新生儿相比，在孕37周（比值比3.9，95%置信区间2.4至6.5）、孕38周（3.0，2.1至4.3）和孕39周（1.9，1.2至3.0）时通过择期剖宫产出生的婴儿发生呼吸疾病的风险增加。严重呼吸疾病风险增加呈现相同模式，但比值比更高：孕37周时增加了五倍（5.0，1.6至16.0）。在排除合并糖尿病、先兆子痫、胎儿生长受限或臀位的妊娠后，这些结果基本保持不变。
与经阴道分娩或急诊剖宫产出生的新生儿相比，足月左右通过择期剖宫产出生的新生儿发生总体和严重呼吸疾病的风险增加。相对风险随孕周减小而增加。
