Åberg Katarina, Norman Mikael, Pettersson Karin, Ekéus Cecilia
Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institute, Stockholm, Sweden.
Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2016 Oct;95(10):1089-96. doi: 10.1111/aogs.12952.
High birthweight is associated with complicated childbirth. The aim of the present study was to investigate the association between birthweight, mode of delivery, and neonatal complications among infants born at term with a birthweight ≥3000 g.
This population-based cohort study used data from the Swedish Medical Birth Register from 1999 to 2012, including 1 030 775 births at >36 completed weeks. Exposure was mode of delivery, categorized into non-instrumental vaginal delivery (VD), emergency cesarean section (CS), vacuum extraction (VE) or cesarean section following attempted vacuum extraction (VE + CS), and birthweight was divided into five categories (3000-3999 g, 4000-4499 g, 4500-4999 g, and ≥5000 g). The following outcomes were assessed: 5-min Apgar score <7, neonatal convulsions, intracranial hemorrhage, and brachial plexus injury. Infants born after VD with a birthweight of 3000-3999 g were used as reference in the logistic regression analysis.
The odds ratios for all complications increased at higher birthweights among infants born after VE/VE + CS and VD. The highest risks were seen after VE/VE + CS with an adjusted odds ratio for neonatal convulsions of 2.6 (95% CI 2.1-3.2) in the reference birthweight group and 6.3 (95% CI 4.3-9.2) among infants with a birthweight of ≥4500 g. The corresponding adjusted odds ratios for intracranial hemorrhage were 2.6 (95% CI 1.7-3.9) and 6.7 (95% CI 3.3-13.6) and for brachial plexus injury 4.0 (95% CI 3.3-4.9) and 88.4 (95% CI 71.9-108.4).
Vacuum extraction is a risk factor for serious neonatal complications, in particular when used in macrosomic fetuses.
高出生体重与分娩并发症相关。本研究的目的是调查足月出生且出生体重≥3000g的婴儿的出生体重、分娩方式和新生儿并发症之间的关联。
这项基于人群的队列研究使用了1999年至2012年瑞典医学出生登记处的数据，包括1030775例孕周>36周的分娩。暴露因素为分娩方式，分为非器械助产阴道分娩（VD）、急诊剖宫产（CS）、真空吸引助产（VE）或真空吸引助产失败后剖宫产（VE + CS），出生体重分为五类（3000 - 3999g、4000 - 4499g、4500 - 4999g和≥5000g）。评估以下结局：5分钟阿氏评分<7分、新生儿惊厥、颅内出血和臂丛神经损伤。在逻辑回归分析中，以出生体重为3000 - 3999g的VD分娩婴儿作为对照。
在VE/VE + CS和VD分娩的婴儿中，出生体重越高，所有并发症的比值比均增加。VE/VE + CS后风险最高，在参考出生体重组中，新生儿惊厥的调整比值比为2.6（95%可信区间2.1 - 3.2），出生体重≥4500g的婴儿中为6.3（95%可信区间4.3 - 9.2）。颅内出血的相应调整比值比分别为2.6（95%可信区间1.7 - 3.9）和6.7（95%可信区间3.3 - 13.6），臂丛神经损伤的调整比值比分别为4.0（95%可信区间3.3 - 4.9）和88.4（95%可信区间71.9 - 108.4）。
真空吸引助产是严重新生儿并发症的危险因素，尤其是用于巨大胎儿时。
