Henriksen L, Schei B, Vangen S, Lukasse M
Section of Obstetrics, Department for Women's and Children's Health, Oslo University Hospital, Oslo, Norway.
BJOG. 2014 Sep;121(10):1237-44. doi: 10.1111/1471-0528.12923. Epub 2014 Jun 18.
This study aimed to explore the association between sexual violence and mode of delivery.
National cohort study.
Women presenting for routine ultrasound examinations were recruited to the Norwegian Mother and Child Cohort Study between 1999 and 2008.
A total of 74,059 pregnant women.
Sexual violence was self-reported during pregnancy using postal questionnaires. Mode of delivery, other maternal birth outcomes and covariates were retrieved from the Medical Birth Registry of Norway. Risk estimations were performed using multivariable logistic regression analysis.
Mode of delivery and selected maternal birth outcomes.
Of 74,059 women, 18.4% reported a history of sexual violence. A total of 10% had an operative vaginal birth, 4.9% had elective caesarean section and 8.6% had an emergency caesarean section. Severe sexual violence (rape) was associated with elective caesarean section, adjusted odds ratio (AOR) 1.56 (95% CI 1.18-2.05) for nulliparous women and 1.37 (1.06-1.76) for multiparous women. Those exposed to moderate sexual violence had a higher risk of emergency caesarean section, AOR 1.31 (1.07-1.60) and 1.41 (1.08-1.84) for nulliparous and multiparous women, respectively. No association was found between sexual violence and operative vaginal birth, except for a lower risk among multiparous women reporting mild sexual violence, AOR 0.73 (0.60-0.89). Analysis of other maternal outcomes showed a reduced risk of episiotomy for women reporting rape and a higher frequency of induced labour.
Women with a history of rape had higher odds of elective caesarean section and induction and significantly fewer episiotomies.
本研究旨在探讨性暴力与分娩方式之间的关联。
全国队列研究。
1999年至2008年期间，参加常规超声检查的女性被纳入挪威母婴队列研究。
总共74059名孕妇。
在孕期通过邮寄问卷进行性暴力情况的自我报告。分娩方式、其他产妇分娩结局及协变量从挪威医疗出生登记处获取。采用多变量逻辑回归分析进行风险评估。
分娩方式及选定的产妇分娩结局。
在74059名女性中，18.4%报告有性暴力史。共有10%进行了阴道助产分娩，4.9%进行了择期剖宫产，8.6%进行了急诊剖宫产。严重性暴力（强奸）与择期剖宫产相关，初产妇的调整优势比（AOR）为1.56（95%可信区间1.18 - 2.05），经产妇为1.37（1.06 - 1.76）。遭受中度性暴力的女性急诊剖宫产风险更高，初产妇和经产妇的AOR分别为1.31（1.07 - 1.60）和1.41（1.08 - 1.84）。除了报告轻度性暴力的经产妇阴道助产分娩风险较低（AOR 0.73，0.60 - 0.89）外，未发现性暴力与阴道助产分娩之间存在关联。对其他产妇结局的分析显示，报告遭受强奸的女性会阴切开术风险降低，引产频率更高。
有强奸史的女性择期剖宫产和引产的几率更高，会阴切开术明显更少。
