INSERM, UMR S953, Epidemiological Research Unit on Perinatal and Women's and Infant's Health, Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2010 Apr;149(2):147-52. doi: 10.1016/j.ejogrb.2009.12.018. Epub 2010 Jan 18.
Given the continuing debate about the benefits of caesarean section for very preterm infants, we sought to describe caesarean section rates for infants between 28 and 31 weeks of gestation in European regions and their association with regional mortality and short-term morbidity.
Singletons and twins without lethal congenital anomalies alive at onset of labour from 28 to 31 weeks of gestation from the 2003 MOSAIC cohort of very preterm births in 10 European regions were analysed (N=3,310). Determinants included maternal and fetal characteristics as well as regional caesarean section rates for all births. We explored correlations between caesarean section rates and mortality and morbidity on the regional level.
95% of infants from pregnancies complicated by hypertension or severe growth restriction detected antenatally were delivered by caesarean section (regional range: 90-100%) versus 55.4% (range: 29-84%) for other pregnancies. Regional caesarean section rates for births at all gestations ranged from 14% to 38% and were correlated with very preterm caesarean rates (p=0.011). Determinants of caesarean section differed between regions with high versus low rates: multiples were more likely to be born by caesarean section in regions with high rates. There were no regional level correlations between caesarean section rates and mortality and morbidity.
With the exception of pregnancies with hypertension and growth restriction, there was broad variation in very preterm caesarean section rates between regions after adjustment for clinical factors. Given maternal risks associated with caesarean section, more research on its optimal use for very preterm deliveries is necessary.
鉴于关于剖宫产对极早产儿益处的持续争论，我们旨在描述欧洲各地区 28 至 31 孕周婴儿的剖宫产率及其与区域死亡率和短期发病率的关系。
对来自 10 个欧洲地区的 2003 年 MOSAIC 极早产儿队列中 28 至 31 孕周活产的单胎和无致死性先天性畸形的双胎进行了分析（N=3310）。确定因素包括母亲和胎儿特征以及所有分娩的区域剖宫产率。我们在区域水平上探讨了剖宫产率与死亡率和发病率之间的相关性。
在产前检测到合并高血压或严重生长受限的妊娠中，95%的婴儿通过剖宫产分娩（区域范围：90-100%），而其他妊娠中这一比例为 55.4%（范围：29-84%）。所有孕周的剖宫产率范围为 14%至 38%，与极早产儿剖宫产率相关（p=0.011）。高剖宫产率和低剖宫产率地区的剖宫产决定因素不同：在高剖宫产率地区，多胎更有可能通过剖宫产分娩。剖宫产率与死亡率和发病率之间没有区域水平的相关性。
在调整了临床因素后，除了高血压和生长受限的妊娠外，各地区极早产儿剖宫产率存在广泛差异。鉴于剖宫产相关的母亲风险，需要进一步研究其在极早产儿分娩中的最佳应用。
