Lilford R J, van Coeverden de Groot H A, Moore P J, Bingham P
Department of Obstetrics and Gynaecology, St James's University Hospital, Leeds, England.
Br J Obstet Gynaecol. 1990 Oct;97(10):883-92. doi: 10.1111/j.1471-0528.1990.tb02442.x.
To compare maternal mortalities attributable to vaginal delivery, elective caesarean section (CS) and intrapartum CS.
The number of deaths associated with each method of delivery was ascertained among unselected and among low-risk women by detailed retrospective review of the case-notes of women who died after delivery. The frequency of each method of delivery throughout the study period was ascertained from the computer database and enhanced by analysis of the case-notes of unselected groups of women.
The Peninsula Maternity Services (Cape Town) during the years 1975-1986 inclusive.
A total of 108 maternal deaths arising from 263,075 maternities provided accurate information. The relative frequency of vaginal and abdominal delivery was determined from the computer database. The ratio of elective CS to emergency prepartum CS to intrapartum CS was obtained by review of the first 200 operations in the years 1975, 1977, 1979, 1982 and 1984.
(i) Mortality rates associated with the different methods of delivery in unselected women and in women who were healthy before surgery; (ii) mortality rates apparently attributable to the method of delivery.
The overall relative risk of mortality associated with caesarean section compared with vaginal delivery was 7 decreasing to 5 after the exclusion of women with medical or life-threatening antenatal complications (eg, haemorrhage, hypertension). The relative risk associated with intrapartum compared with elective sections was 2.3 decreasing to 1.4 after the exclusion of women with medical disorders or life-threatening complications. The relative risk of maternal mortality which was apparently attributable to intrapartum compared with elective sections was 1.7. However, the 95% confidence intervals of these values, even from this large data-set, are wide. Nevertheless, these rates are in broad agreement with an approximation derived from the British confidential enquiries into maternal deaths.
The attributable relative mortalities of caesarean section compared with vaginal delivery and intrapartum compared with elective caesarean section are lower than the overall relative mortalities of these modes of delivery and are approximately 5:1 and 1.5:1 respectively. These data are crucially important in the decision to recommend elective caesarean section compared with trial of labour.
比较阴道分娩、择期剖宫产和产时剖宫产所致的孕产妇死亡情况。
通过对分娩后死亡妇女的病历进行详细回顾性审查，确定未选择人群和低风险妇女中与每种分娩方式相关的死亡人数。从计算机数据库中确定整个研究期间每种分娩方式的频率，并通过对未选择的妇女群体病历的分析加以补充。
1975年至1986年期间的半岛产科服务机构（开普敦）。
在263,075例分娩中发生的108例孕产妇死亡提供了准确信息。从计算机数据库中确定阴道分娩和剖宫产的相对频率。通过回顾1975年、1977年、1979年、1982年和1984年的前200例手术，得出择期剖宫产与产前急诊剖宫产与产时剖宫产的比例。
（i）未选择妇女和术前健康妇女中与不同分娩方式相关的死亡率；（ii）明显归因于分娩方式的死亡率。
与阴道分娩相比，剖宫产相关的总体相对死亡风险为7，排除有医疗或危及生命的产前并发症（如出血、高血压）的妇女后降至5。与择期剖宫产相比，产时剖宫产相关的相对风险为2.3，排除有疾病或危及生命并发症的妇女后降至1.4。与择期剖宫产相比，明显归因于产时剖宫产的孕产妇死亡相对风险为1.7。然而，即使从这个大数据集中得出，这些值的95%置信区间也很宽。尽管如此，这些比率与英国孕产妇死亡保密调查得出的近似值大致一致。
与阴道分娩相比，剖宫产的归因相对死亡率以及与择期剖宫产相比产时剖宫产的归因相对死亡率低于这些分娩方式的总体相对死亡率，分别约为5:1和1.5:1。这些数据在决定推荐择期剖宫产与试产相比时至关重要。
