剖宫产与脑瘫：系统评价与荟萃分析。

Cesarean delivery and cerebral palsy: a systematic review and meta-analysis.

机构信息

Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia.

出版信息

Obstet Gynecol. 2013 Dec;122(6):1169-75. doi: 10.1097/AOG.0000000000000020.

DOI:10.1097/AOG.0000000000000020

PMID:24201683

Abstract

OBJECTIVE

To examine the association of cesarean delivery and cerebral palsy using a systematic literature review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, and ClinicalTrials.gov were systematically searched for articles relating to cerebral palsy and cesarean delivery from inception until December 2012. Only articles reporting confirmed cases of cerebral palsy were included. Meta-analysis was used to assess combined results and also the following subgroups: emergency cesarean; elective cesarean; term delivery; preterm delivery; and delivery of breech-presenting newborns.

METHODS OF STUDY SELECTION

Literature searches returned 1,874 articles with 58 considered in full. Studies were selected if they reported an endpoint of cerebral palsy, an intervention or risk of cesarean delivery, were in English, and gave sufficient details to perform meta-analysis.

TABULATION, INTEGRATION, AND RESULTS: Nine case-control and four cohort studies were included in the overall analysis. Meta-analysis showed no overall association of cesarean delivery with cerebral palsy (odds ratio [OR] 1.29; 95% confidence interval [CI] 0.92-1.79; 3,810 case group participants and 1,692,580 control group participants). Emergency cesarean delivery was associated with increased risk of cerebral palsy (OR 2.17; 95% CI 1.58-2.98), whereas there was no significant association between elective cesarean delivery and cerebral palsy (OR 0.81; 95% CI 0.41-1.58). Any type of cesarean delivery (elective or emergency) for term newborns was associated with cerebral palsy (OR 1.6; 95% CI 1.05-2.44), whereas there was no association between any type of cesarean delivery and cerebral palsy in preterm newborns (OR 0.81; 95% CI 0.47-1.40). Cesarean delivery did not significantly modify cerebral palsy risk for breech-presenting newborns (OR 0.51; 95% CI 0.13-2.05).

CONCLUSION

A review of the literature does not support the use of elective or emergency cesarean delivery to prevent cerebral palsy.

摘要

目的

通过系统文献回顾和荟萃分析，研究剖宫产与脑瘫的关联。

资料来源

从建库至 2012 年 12 月，系统检索 MEDLINE、Embase 和 ClinicalTrials.gov 中有关脑瘫与剖宫产的文献，纳入脑瘫确诊病例的相关文章。荟萃分析用于评估综合结果和以下亚组：紧急剖宫产、择期剖宫产、足月产、早产和臀位分娩。

研究选择方法

文献检索共返回 1874 篇文章，其中 58 篇文章进行了全文评估。如果研究报告了脑瘫的终点、剖宫产的干预或风险、使用英语且提供了足够的详细信息进行荟萃分析，则将其纳入研究。

列表、整合和结果：共有 9 项病例对照研究和 4 项队列研究纳入总体分析。荟萃分析显示剖宫产与脑瘫无总体相关性（比值比 [OR] 1.29；95%置信区间 [CI] 0.92-1.79；3810 例病例组参与者和 1692580 例对照组参与者）。急诊剖宫产与脑瘫风险增加相关（OR 2.17；95%CI 1.58-2.98），而择期剖宫产与脑瘫无显著相关性（OR 0.81；95%CI 0.41-1.58）。对于足月新生儿，任何类型的剖宫产（择期或急诊）与脑瘫相关（OR 1.6；95%CI 1.05-2.44），而对于早产儿，任何类型的剖宫产与脑瘫均无相关性（OR 0.81；95%CI 0.47-1.40）。剖宫产对臀位新生儿的脑瘫风险无显著影响（OR 0.51；95%CI 0.13-2.05）。