Division of Vital Statistics, National Center for Health Statistics, Hyattsville, MD 20782, USA.
Am J Public Health. 2010 Nov;100(11):2241-7. doi: 10.2105/AJPH.2009.180570. Epub 2010 Sep 23.
We examined the relationship between obstetrical intervention and preterm birth in the United States between 1991 and 2006.
We assessed changes in preterm birth, cesarean delivery, labor induction, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention after risk adjustment.
From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI] = 1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor.
Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions.
我们研究了 1991 年至 2006 年期间美国产科干预与早产之间的关系。
我们评估了早产、剖宫产、引产及相关风险的变化。通过逻辑回归模型对风险调整后早产产科干预的可能性进行了评估。
1991 年至 2006 年期间，单胎早产的百分比增加了 13%。单胎早产的剖宫产率增加了 47%，引产率增加了一倍。2006 年，51%的单胎早产是自然阴道分娩，而 1991 年这一比例为 69%。在调整了人口统计学和医疗风险因素后，2006 年早产婴儿的母亲进行产科干预的可能性比 1991 年增加了 88%（95%置信区间[CI] = 1.87，1.90）。利用来自 19 个州的新出生证明数据，我们估计 42%的单胎早产婴儿是通过引产或剖宫产分娩的，而不是自发发动分娩。
产科干预与 1991 年至 2006 年期间美国早产率的增加有关。公共卫生界可以在减少不必要的医学干预方面发挥核心作用。
