Reis Zilma Silveira Nogueira, Lage Eura Martins, Aguiar Regina Amelia Lopes Pessoa, Gaspar Juliano de Souza, Vitral Gabriela Luiza Nogueira, Machado Eliana Goncalves
Departamento de Ginecologia e Obstetricia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Programa de Pos-Graduacao em Saude da Mulher, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Rev Bras Ginecol Obstet. 2014 Feb;36(2):65-71.
To analyze the relationships among gestational risk, type of delivery and immediate maternal and neonatal repercussions.
A retrospective cohort study based on secondary data was conducted in a university maternity hospital. A total of 1606 births were analyzed over a 9-month period. Epidemiological, clinical, obstetric and neonatal characteristics were compared according to the route of delivery and the gestational risk characterized on the basis of the eligibility criteria for high clinical risk. The occurrence of maternal and neonatal complications during hospitalization was analyzed according to gestational risk and cesarean section delivery using univariate and multivariate logistic analysis.
The overall rate of cesarean sections was 38.3%. High gestational risk was present in 50.2% of births, mainly represented by hypertensive disorders and fetal malformations. The total incidence of cesarean section, planned cesarean section or emergency cesarean section was more frequent in pregnant women at gestational high risk (p<0.001). Cesarean section alone did not influence maternal outcome, but was associated with poor neonatal outcome (OR 3.4; 95%CI 2.7-4.4). Gestational high risk was associated with poor maternal and neonatal outcome (OR 3.8; 95%CI 1.3-8.7 and OR 17.5; 95%CI 11.6-26.3, respectively). In multivariate analysis, the ratios were maintained, although the effect of gestational risk has determined a reduction in the OR of the type of delivery alone from 3.4 (95%CI 2.7-4.4) to 1.99 (95%CI 1.5-2.6) for adverse neonatal outcome.
Gestational risk was the main factor associated with poor maternal and neonatal outcome. Cesarean delivery was not directly associated with poor maternal outcome but increased the chances of unfavorable neonatal outcomes.
分析妊娠风险、分娩方式与产妇及新生儿近期影响之间的关系。
在一家大学附属医院进行了一项基于二手数据的回顾性队列研究。在9个月的时间里共分析了1606例分娩。根据分娩途径以及基于高临床风险纳入标准所确定的妊娠风险，比较了流行病学、临床、产科和新生儿特征。采用单因素和多因素逻辑回归分析，根据妊娠风险和剖宫产分娩情况分析住院期间产妇和新生儿并发症的发生情况。
剖宫产的总体发生率为38.3%。50.2%的分娩存在高妊娠风险，主要表现为高血压疾病和胎儿畸形。高妊娠风险孕妇的剖宫产、计划剖宫产或急诊剖宫产的总发生率更高（p<0.001）。单纯剖宫产对产妇结局无影响，但与新生儿不良结局相关（比值比3.4；95%置信区间2.7 - 4.4）。高妊娠风险与产妇和新生儿不良结局相关（比值比分别为3.8；95%置信区间1.3 - 8.7和17.5；95%置信区间11.6 - 26.3）。在多因素分析中，尽管妊娠风险的影响已使单纯分娩方式对不良新生儿结局的比值比从3.4（95%置信区间2.7 - 4.4）降至1.99（95%置信区间1.5 - 2.6），但这些比值仍保持不变。
妊娠风险是与产妇和新生儿不良结局相关的主要因素。剖宫产与产妇不良结局无直接关联，但增加了新生儿出现不良结局的几率。
