高龄产妇年龄和分娩干预：一项基于人群的研究，比较澳大利亚维多利亚州的高龄和年轻初产妇。

Older maternal age and intervention in labor: a population-based study comparing older and younger first-time mothers in Victoria, Australia.

机构信息

School of Nursing and Midwifery, St Alban's Campus, Victoria University, Melbourne, Victoria, Australia.

出版信息

Birth. 2011 Mar;38(1):24-9. doi: 10.1111/j.1523-536X.2010.00439.x. Epub 2010 Dec 23.

DOI:10.1111/j.1523-536X.2010.00439.x

PMID:21332771

Abstract

BACKGROUND

In Australia, birth rates for women aged 35 years or more are significant and increasing and a considerable percentage are first births. This study investigated the effect of maternal age on interventions in labor and birth for primiparous women aged 35 to 44 years compared with primiparous women aged 25 to 29 years.

METHODS

All primiparous women who gave birth in Victoria, Australia, in 2005 and 2006 (n = 57,426) were included in this population-based cross-sectional study. Women were stratified by admission status (private/public). Main outcome measures were induction of labor, augmentation of labor, use of epidural analgesia, and method of birth. Multivariate logistic regression was used to explore the relationship between maternal age and cesarean adjusted for confounders.

RESULTS

Older women were more likely to give birth by cesarean section whether admitted as public or private patients. For private patients, total cesarean rates were 31.8 percent (25-29 yr), 46.0 percent (35-39 yr), and 60.0 percent (40-44 yr; p < 0.001) compared with 27.5, 41.6, and 53.4 percent for public patients (p < 0.001). Older women who experienced labor were more likely to have an instrumental vaginal birth or an emergency cesarean section than younger women. Both were more common in women admitted as private patients. Age-related trends were also seen for induction of labor and use of epidural analgesia. Rates were higher for private patients. Rates of induction were (37.8, 40.2, and 42.5%) for private patients compared with (32.1, 36.7, and 40.1%) for public patients and rates for epidural were (45.3, 49.9, and 48.1%) among private patients compared with (33.3, 38.8, and 39.3%) among public patients.

CONCLUSIONS

Interventions in labor and birth increased with maternal age, and this effect was seen particularly for cesarean section among women admitted privately. These findings were not fully explained by the complications we considered.

摘要

背景

在澳大利亚，35 岁及以上女性的出生率显著且呈上升趋势，其中相当一部分为初产妇。本研究旨在调查与 25-29 岁的初产妇相比，35-44 岁的初产妇的产程干预措施及分娩方式的变化。

方法

该研究为基于人群的病例对照研究，纳入了 2005 年和 2006 年在澳大利亚维多利亚州分娩的所有初产妇（n=57426）。根据入院情况（私立/公立）将产妇分层。主要结局指标包括引产、催产、硬膜外镇痛的使用以及分娩方式。采用多变量逻辑回归分析调整混杂因素后，产妇年龄与剖宫产的关系。

结果

无论私立或公立，产妇年龄越大，行剖宫产分娩的可能性越高。对于私立患者，总剖宫产率分别为 31.8%（25-29 岁）、46.0%（35-39 岁）和 60.0%（40-44 岁；p<0.001），而公立患者则分别为 27.5%、41.6%和 53.4%（p<0.001）。经历产程的高龄产妇比年轻产妇更有可能行产钳助产或急诊剖宫产，且这些情况在私立患者中更为常见。此外，产妇年龄与引产和硬膜外镇痛的使用也存在相关性。私立患者的这些指标更高。私立患者的引产率分别为（37.8%、40.2%和 42.5%），公立患者则分别为（32.1%、36.7%和 40.1%），私立患者的硬膜外镇痛率分别为（45.3%、49.9%和 48.1%），公立患者则分别为（33.3%、38.8%和 39.3%）。