Subramaniam Akila, Jauk Victoria Chapman, Goss Amy Reed, Alvarez Mitchell Dean, Reese Crystal, Edwards Rodney Kirk
Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL.
Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL.
Am J Obstet Gynecol. 2014 Dec;211(6):700.e1-9. doi: 10.1016/j.ajog.2014.06.045. Epub 2014 Jun 20.
To compare maternal and neonatal outcomes between planned cesarean delivery and induction of labor in women with class III obesity (body mass index ≥40 kg/m(2)).
In this retrospective cohort study, we identified all women with a body mass index ≥40 kg/m(2) who delivered a singleton at our institution from January 2007 to February 2013 via planned cesarean or induction of labor (regardless of eventual delivery route) at 37-41 weeks. Patients in spontaneous labor were excluded. The primary outcome was a composite of maternal morbidity including death as well as operative, infection, and thromboembolic complications. The secondary outcome was a neonatal morbidity composite. Additional outcomes included individual components of the composites. Student t, χ(2), and Fisher exact tests were used for statistical analysis. To calculate adjusted odds ratios, covariates were analyzed via multivariable logistic regression.
There are 661 mother-infant pairs that met enrollment criteria-399 inductions and 262 cesareans. Groups were similar in terms of prepregnancy weight, pregnancy weight gain, and delivery body mass index. Of the 399 inductions, 258 had cervical ripening (64.7%) and 163 (40.9%) had a cesarean delivery. After multivariable adjustments, there was no significant difference in the maternal morbidity composite (adjusted odds ratio, 0.98; 95% confidence interval, 0.55-1.77) or in the neonatal morbidity composite (adjusted odds ratio, 0.81; 95% confidence interval, 0.37-1.77) between the induction and cesarean groups.
In term pregnant women with class III obesity, planned cesarean does not appear to reduce maternal and neonatal morbidity compared with induction of labor.
比较Ⅲ级肥胖（体重指数≥40kg/m²）女性计划剖宫产与引产的母婴结局。
在这项回顾性队列研究中，我们确定了2007年1月至2013年2月期间在我院通过计划剖宫产或引产（无论最终分娩方式）在37 - 41周分娩单胎的所有体重指数≥40kg/m²的女性。自然临产的患者被排除。主要结局是包括死亡以及手术、感染和血栓栓塞并发症在内的孕产妇发病率综合指标。次要结局是新生儿发病率综合指标。其他结局包括综合指标的各个组成部分。采用学生t检验、χ²检验和Fisher精确检验进行统计分析。为计算调整后的比值比，通过多变量逻辑回归分析协变量。
有661对母婴符合纳入标准，其中399例引产，262例剖宫产。两组在孕前体重、孕期体重增加和分娩时体重指数方面相似。在399例引产中，258例（64.7%）进行了宫颈成熟，163例（40.9%）进行了剖宫产。多变量调整后，引产组和剖宫产组在孕产妇发病率综合指标（调整后的比值比为0.98；95%置信区间为0.55 - 1.77）或新生儿发病率综合指标（调整后的比值比为0.81；95%置信区间为0.37 - 1.77）方面无显著差异。
对于Ⅲ级肥胖的足月孕妇，与引产相比，计划剖宫产似乎并未降低母婴发病率。
