Heinzmann Andrea, Brugger Markus, Engels Christina, Prömpeler Heinrich, Superti-Furga Andrea, Strauch Konstantin, Krueger Marcus
Centre for Pediatrics and Adolescent Medicine, University of Freiburg, Mathildenstrasse 1, Freiburg, Germany.
Acta Paediatr. 2009 Jan;98(1):25-30. doi: 10.1111/j.1651-2227.2008.01150.x.
The incidence of caesarean section (CS) is steadily rising world-wide. In particular, CS on maternal demand is performed more frequently. In parts, this might be due to insufficient information of pregnant women about neonatal risks of CS. We sought to specify neonatal outcomes following different modes of delivery, i.e. vaginal delivery, primary CS and secondary CS and to define risk factors for respiratory morbidity and hospitalization.
We analysed 2073 births (gestational age > 35 weeks) during a two-year period at a tertiary obstetric and neonatal centre in Germany. Statistical analyses were performed for single parameters by SPSS as well as by logistic regression to account for possible confounders. Furthermore, extensive model calculation was done.
Respiratory morbidity was increased following primary and secondary CS (p = 0.001). By multiple logistic regression, the strongest effect on respiratory symptoms was seen with gestational age, each week more in utero reducing the risk by an odds ratio (OR) of 0.69 (95% CI: [0.61; 0.79]; p = 1.9 x 10(-8)). Furthermore, a significant interaction between mode of delivery and gestational age was found for the risk of respiratory symptoms (p = 0.0035).
For every eight newborns delivered by primary CS one more than expected with vaginal delivery is hospitalized. It is highly relevant to recognize that each week of gestational age reduces the risk of respiratory symptoms, especially if primary CS is performed. The higher rate of respiratory morbidity and neonatal admission following CS should be clearly recognized in counselling of pregnant women.
剖宫产（CS）的发生率在全球范围内稳步上升。特别是，因产妇要求而进行的剖宫产更为频繁。部分原因可能是孕妇对剖宫产的新生儿风险了解不足。我们试图明确不同分娩方式（即阴道分娩、初次剖宫产和再次剖宫产）后的新生儿结局，并确定呼吸疾病和住院的危险因素。
我们分析了德国一家三级产科和新生儿中心两年内2073例出生（孕周>35周）的情况。通过SPSS对单个参数进行统计分析，并通过逻辑回归分析以考虑可能的混杂因素。此外，还进行了广泛的模型计算。
初次和再次剖宫产后呼吸疾病发生率增加（p = 0.001）。通过多元逻辑回归分析，对呼吸症状影响最强的是孕周，每多在子宫内待一周，风险降低的比值比（OR）为0.69（95%可信区间：[0.61；0.79]；p = 1.9×10⁻⁸）。此外，发现分娩方式和孕周之间在呼吸症状风险方面存在显著交互作用（p = 0.0035）。
每8例通过初次剖宫产分娩的新生儿中，就有1例比预期经阴道分娩的新生儿住院。认识到孕周每增加一周都会降低呼吸症状的风险非常重要，尤其是在进行初次剖宫产时。在为孕妇提供咨询时，应清楚认识到剖宫产后呼吸疾病发生率和新生儿入院率较高的情况。
