Jacob Louis, Weber Katherina, Sechet Ingeborg, Macharey Georg, Kostev Karel, Ziller Volker
Department of Biology, École Normale Supérieure de Lyon, Lyon, France.
Department of Gyn. Endocrinology and Reproductive Medicine, Hospital of Gynecology and Obstetrics University Hospital Gießen und Marburg, Baldingerstraße, 35033, Marburg, Germany.
Arch Gynecol Obstet. 2016 Nov;294(5):1005-1010. doi: 10.1007/s00404-016-4160-4. Epub 2016 Aug 3.
To analyze the impact of caesarean section (CS) on fertility and time to pregnancy in German gynecological practices.
Women initially diagnosed for the first time with a vaginal delivery (VD) or CS between 2000 and 2013 were identified by 227 gynecologists in the IMS Disease Analyzer database. They were included if they were aged between 16 and 40 years, and were not previously diagnosed with female sterility. The two main outcomes were the first-time diagnosis of female sterility and the time between the first delivery and the next pregnancy within 10 years. A multivariate Cox regression model was used to predict these outcomes on the basis of patient characteristics.
6483 patients were included in the CS group and 6483 in the VD group. Mean age was 30.6 years and the proportion of individuals with private health insurance amounted to 9.0 %. Within 10 years of the index date, 19.5 % of women who delivered by CS and 18.3 % of women who delivered vaginally were diagnosed with sterility (p value = 0.0148). CS and polycystic ovary syndrome significantly increased the risk of sterility. Within 10 years of the index date, 57.9 % of women who underwent a CS and 64.0 % of women who delivered vaginally were pregnant for the second time (p value <0.001). CS, polycystic ovary syndrome, and the deterioration of menstrual cycle significantly decreased the chance of becoming pregnant a second time.
CS is associated with an increased risk of sterility and a decreased number of subsequent pregnancies in Germany.
分析剖宫产（CS）对德国妇科诊疗中生育能力及再次妊娠时间的影响。
通过IMS疾病分析器数据库中的227名妇科医生，识别出2000年至2013年间首次诊断为顺产（VD）或剖宫产的女性。纳入标准为年龄在16至40岁之间，且此前未被诊断为女性不育。两个主要结局是首次诊断为女性不育以及首次分娩与10年内再次妊娠之间的时间。使用多变量Cox回归模型根据患者特征预测这些结局。
剖宫产组纳入6483例患者，顺产组纳入6483例患者。平均年龄为30.6岁，拥有私人医疗保险的个体比例为9.0%。在索引日期后的10年内，剖宫产分娩的女性中有19.5%被诊断为不育，顺产分娩的女性中有18.3%被诊断为不育（p值 = 0.0148）。剖宫产和多囊卵巢综合征显著增加了不育风险。在索引日期后的10年内，接受剖宫产的女性中有57.9%第二次怀孕，顺产分娩的女性中有64.0%第二次怀孕（p值<0.001）。剖宫产、多囊卵巢综合征和月经周期恶化显著降低了第二次怀孕的几率。
在德国，剖宫产与不育风险增加及后续妊娠次数减少有关。
