Solheim Karla N, Esakoff Tania F, Little Sarah E, Cheng Yvonne W, Sparks Teresa N, Caughey Aaron B
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
J Matern Fetal Neonatal Med. 2011 Nov;24(11):1341-6. doi: 10.3109/14767058.2011.553695. Epub 2011 Mar 7.
The overall annual incidence rate of caesarean delivery in the United States has been steadily rising since 1996, reaching 32.9% in 2009. Primary cesareans often lead to repeat cesareans, which may lead to placenta previa and placenta accreta. This study's goal was to forecast the effect of rising primary and secondary cesarean rates on annual incidence of placenta previa, placenta accreta, and maternal mortality.
A decision-analytic model was built using TreeAge Pro software to estimate the future annual incidence of placenta previa, placenta accreta, and maternal mortality using data on national birthing order trends and cesarean and vaginal birth after cesarean rates. Baseline assumptions were derived from the literature, including the likelihood of previa and accreta among women with multiple previous cesarean deliveries.
If primary and secondary cesarean rates continue to rise as they have in recent years, by 2020 the cesarean delivery rate will be 56.2%, and there will be an additional 6236 placenta previas, 4504 placenta accretas, and 130 maternal deaths annually. The rise in these complications will lag behind the rise in cesareans by approximately 6 years.
If cesarean rates continue to increase, the annual incidence of placenta previa, placenta accreta, and maternal death will also rise substantially.
自1996年以来，美国剖宫产的总体年发生率一直在稳步上升，2009年达到32.9%。初次剖宫产往往会导致再次剖宫产，这可能会导致前置胎盘和胎盘植入。本研究的目的是预测初次和二次剖宫产率上升对前置胎盘、胎盘植入的年发生率以及孕产妇死亡率的影响。
使用TreeAge Pro软件建立了一个决策分析模型，利用全国分娩顺序趋势以及剖宫产和剖宫产后阴道分娩率的数据，来估计未来前置胎盘、胎盘植入的年发生率以及孕产妇死亡率。基线假设源自文献，包括多次既往剖宫产妇女中前置胎盘和胎盘植入的可能性。
如果初次和二次剖宫产率继续像近年来那样上升，到2020年剖宫产率将达到56.2%，每年将新增6236例前置胎盘、4504例胎盘植入以及130例孕产妇死亡。这些并发症的增加将比剖宫产率的增加滞后约6年。
如果剖宫产率继续上升，前置胎盘、胎盘植入的年发生率以及孕产妇死亡率也将大幅上升。
