School of Public Health, Central South University, Changsha, Hunan, PR China.
Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):204-8. doi: 10.1016/j.ejogrb.2011.05.006.
To examine impact of cesarean delivery in first pregnancy on neonatal mortality and morbidity in second pregnancy.
Retrospective cohort study using 1995-2002 US birth registration data. Neonatal mortality and morbidity in second pregnancy of cesarean deliveries in the first pregnancy were compared with vaginal deliveries in the first pregnancy.
A total of 9,643,175 singleton second births were eligible in the analysis after excluding those with unknown delivery method (1,801,339 with a previous cesarean delivery and 7,841,836 with a previous vaginal delivery). Compared with vaginal delivery group, infants born to mothers with a previous cesarean delivery had increased risks of assisted ventilation (OR=1.47, 95% CI 1.46, 1.49), low Apgar's score (OR=1.14, 95% CI 1.12, 1.17), seizure (OR=1.36, 95% CI 1.27, 1.45), fetal distress (OR=1.46, 95% CI 1.44, 1.47), and asphyxia-related neonatal death (OR=1.40, 95% CI 1.29, 1.52). The association between mode of delivery in first pregnancy and neonatal outcomes in second pregnancy remained the same after excluding women with chronic health problems or adverse birth history and adjusting for potential confounding factors.
CONCLUSION(S): Cesarean delivery in first pregnancy is associated with increased risks of neonatal morbidity and mortality in second pregnancy.
探讨首次剖宫产分娩对再次妊娠新生儿病死率和发病率的影响。
采用 1995 年至 2002 年美国出生登记数据进行回顾性队列研究。比较首次剖宫产分娩的再次妊娠的新生儿病死率和发病率与首次阴道分娩的再次妊娠。
在排除了未知分娩方式的病例（1801339 例有既往剖宫产史，7841836 例有既往阴道分娩史）后，共有 9643175 例单胎二次分娩符合分析条件。与阴道分娩组相比，有既往剖宫产史的母亲所生婴儿使用辅助通气的风险增加（OR=1.47，95%CI 1.46，1.49），低 Apgar 评分（OR=1.14，95%CI 1.12，1.17）、癫痫（OR=1.36，95%CI 1.27，1.45）、胎儿窘迫（OR=1.46，95%CI 1.44，1.47）和窒息相关新生儿死亡（OR=1.40，95%CI 1.29，1.52）。排除患有慢性健康问题或不良分娩史的妇女，并调整潜在混杂因素后，首次妊娠分娩方式与再次妊娠新生儿结局之间的关联仍然存在。
首次剖宫产分娩与再次妊娠新生儿发病率和病死率增加相关。
