Winovitch Kim C, Padilla Lupe, Ghamsary Mark, Lagrew David C, Wing Deborah A
Department of Obstetrics-Gynecology, Division of Maternal-Fetal Medicine, University of California, Irvine/Long Beach Memorial Medical Center/Miller Children's Hospital, Orange, California, USA.
J Matern Fetal Neonatal Med. 2011 Nov;24(11):1398-402. doi: 10.3109/14767058.2010.551681. Epub 2011 Sep 21.
To evaluate the frequency of persistent pulmonary hypertension of the newborn (PPHN) following elective cesarean at greater than 34 weeks' gestation in an academically affiliated community hospital.
Retrospective cohort study involving chart review of 300 newborns with PPHN between 1999 and 2006. Infants less than 34 weeks' or with congenital anomalies were excluded. Subjects were divided into two groups: (1) intended vaginal delivery and (2) elective cesarean.
A total of 125 neonates were included. In all, 46 were delivered vaginally, 53 by cesarean after a trial of labor, and 26 by elective cesarean. No statistically significant differences were noted between groups in birth weight, gestational age, or length of stay. The crude relative risk (RR) of PPHN in cesareans prior to labor (elective cesareans) when compared to intended vaginal deliveries was 2.0 (95% CI 1.3-3.1). The RR of PPHN in elective cesareans when compared to spontaneous labor resulting in vaginal deliveries was 3.4 (95% CI 2.1-5.5). The adjusted RRs for these outcomes comparing the same delivery groups when considering gestational age at birth (less vs. equal to or more than 37 weeks') were 2.2 (95% CI 1.4-3.4) and 3.7 (95% CI 2.3-6.1), and birth weight (less vs. equal to or more than 2500 g) were 1.9 (95% 1.3-3.0) and 3.4 (95% CI 2.1-5.5), respectively. The incidence of PPHN in the elective cesarean group was 6.9 per 1000 deliveries. The number of cesareans to be avoided to prevent one case of PPHN in this cohort was 387 (number needed to harm, 95% CI 206.8-3003.1).
Our findings include a high rate of PPHN following elective cesarean delivery, and suggest that physicians should consider this added morbidity when performing elective cesareans.
评估在一所大学附属医院社区医院中，孕34周以上择期剖宫产术后新生儿持续性肺动脉高压（PPHN）的发生频率。
回顾性队列研究，对1999年至2006年间300例PPHN新生儿病历进行审查。排除孕周小于34周或有先天性异常的婴儿。研究对象分为两组：（1）计划经阴道分娩组；（2）择期剖宫产组。
共纳入125例新生儿。其中，46例经阴道分娩，53例经试产后剖宫产，26例择期剖宫产。各组在出生体重、孕周或住院时间方面无统计学显著差异。与计划经阴道分娩相比，临产前剖宫产（择期剖宫产）发生PPHN的粗相对风险（RR）为2.0（95%可信区间1.3 - 3.1）。与自然分娩经阴道分娩相比，择期剖宫产发生PPHN的RR为3.4（95%可信区间2.1 - 5.5）。在考虑出生孕周（小于37周与等于或大于37周）时，比较相同分娩组这些结局的校正RR分别为2.2（95%可信区间1.4 - 3.4）和3.7（95%可信区间2.3 - 6.1）；在考虑出生体重（小于2500克与等于或大于2500克）时，校正RR分别为1.9（95%可信区间1.3 - 3.0）和3.4（95%可信区间2.1 - 5.5）。择期剖宫产组PPHN的发生率为每1000例分娩6.9例。在此队列中，为预防1例PPHN需要避免的剖宫产数量为387例（伤害所需数量，95%可信区间206.8 - 3003.）。
我们的研究结果显示择期剖宫产术后PPHN发生率较高，提示医生在进行择期剖宫产时应考虑到这一额外的发病率。
