诗里那林医院足月妊娠无并发症情况下，再次剖宫产与正常阴道分娩的新生儿发病率及死亡率对比

Neonatal morbidity and mortality for repeated cesarean section vs. normal vaginal delivery to uncomplicated term pregnancies at Srinagarind Hospital.

作者信息

Wankaew Nootwadee, Jirapradittha Junya, Kiatchoosakun Pakaphan

机构信息

Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

出版信息

J Med Assoc Thai. 2013 Jun;96(6):654-60.

PMID:23951821

Abstract

OBJECTIVE

To evaluate the morbidities and mortality of neonates delivered by elective repeated cesarean section vs. normal vaginal delivery among women with uncomplicated term pregnancies.

MATERIAL AND METHOD

A retrospective descriptive study was done between January 2009 and December 2011 to determine the morbidities and mortality among uncomplicated term pregnancies at Srinagarind Hospital. Three hundred seventy two neonates delivered by elective repeated cesarean section vs. 1,581 by normal vaginal delivery.

RESULTS

A significantly greater number of neonates in the elective repeated cesarean section group required oxygen for neonatal resuscitation compared to neonates in the normal vaginal delivery group (37.6% vs. 20.9%, p < 0.001). Neonates delivered by elective repeated cesarean section were more frequently admitted to the neonatal intensive care unit (1.1% vs. 0%, p < 0.001) and had longer hospital stays (4.56 +/- 2.45 vs. 4.07 +/- 1.44 days, p < 0.001). The latter not only had a higher rate of respiratory distress syndrome (0.8% vs. 0%, p < 0.001) and transient tachypnea of the newborn (3.2% vs. 0.3%, p < 0.001), which required more respiratory support, they also had a higher rate of infection (2.4% vs. 0.8%, p < 0.05) than neonates delivered by normal vaginal delivery. Neonates born by normal vaginal delivery, however had more birth trauma and hyperbilirubinemia than neonates born by elective repeated cesarean section (8.8% vs. 2.4%, p < 0.001 and 31.8% vs. 22.6%, p < 0.05, respectively). There was no difference in the mortality rate between the groups.

CONCLUSION

Even among uncomplicated term pregnancies, cesarean section is associated with more neonatal respiratory morbidity and sepsis while those delivered by normal vaginal delivery tend to have a higher rate of birth trauma and hyperbilirubinemia. Clinicians should therefore be concerned about the route of delivery and the probability of negative neonatal outcomes.

摘要

目的

评估择期再次剖宫产与正常阴道分娩的足月妊娠无并发症产妇所分娩新生儿的发病率和死亡率。

材料与方法

2009年1月至2011年12月在诗琳通医院进行了一项回顾性描述性研究，以确定足月妊娠无并发症产妇所分娩新生儿的发病率和死亡率。372例新生儿通过择期再次剖宫产分娩，1581例通过正常阴道分娩。

结果

与正常阴道分娩组的新生儿相比，择期再次剖宫产组中有显著更多的新生儿需要吸氧进行新生儿复苏（37.6%对20.9%，p<0.001）。择期再次剖宫产分娩的新生儿更频繁地入住新生儿重症监护病房（1.1%对0%，p<0.001），且住院时间更长（4.56±2.45天对4.07±1.44天，p<0.001）。后者不仅呼吸窘迫综合征发生率更高（0.8%对0%，p<0.001），新生儿短暂性呼吸急促发生率更高（3.2%对0.3%，p<0.001），需要更多呼吸支持，其感染率也高于正常阴道分娩的新生儿（2.4%对0.8%，p<0.05）。然而，正常阴道分娩的新生儿比择期再次剖宫产出生的新生儿有更多的产伤和高胆红素血症（分别为8.8%对2.4%，p<0.001和31.8%对22.6%，p<0.05）。两组之间的死亡率无差异。