Herstad Lina, Klungsøyr Kari, Skjærven Rolv, Tanbo Tom, Forsén Lisa, Åbyholm Thomas, Vangen Siri
Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen, N-0424, Oslo, Norway.
Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.
BMC Pregnancy Childbirth. 2016 Aug 17;16:230. doi: 10.1186/s12884-016-1028-3.
Maternal age at delivery and cesarean section rates are increasing. In older women, the decision on delivery mode may be influenced by a reported increased risk of surgical interventions during labor and complications with increasing maternal age. We examined the association between maternal age and adverse outcomes in low-risk primiparous women, and the risk of adverse outcomes by delivery modes, both planned and performed (elective and emergency cesarean section, operative vaginal delivery, and unassisted vaginal delivery) in women aged ≥ 35 years.
A population-based registry study was conducted using data from the Medical Birth Registry of Norway and Statistics Norway including 169,583 low-risk primiparas with singleton, cephalic labors at ≥ 37 weeks during 1999 - 2009. Outcomes studied were obstetric blood loss, maternal transfer to intensive care units, 5-min Apgar score, and neonatal complications. We adjusted for potential confounders using relative risk models and multinomial logistic regression.
Most adverse outcomes increased with increasing maternal age. However, the increase in absolute risks was low, except for moderate obstetric blood loss and transfer to the neonatal intensive care unit (NICU). Operative deliveries increased with increasing maternal age and in women aged ≥ 35 years, the risk of maternal complications in operative delivery increased. Neonatal adverse outcomes increased mainly in emergency operative deliveries. Moderate blood loss was three times more likely in elective and emergency cesarean section than in unassisted vaginal delivery, and twice as likely in operative vaginal delivery. Low Apgar score and neonatal complications occurred two to three times more often in emergency operative deliveries than in unassisted vaginal delivery. However, comparing outcomes after elective cesarean section and planned vaginal delivery, only moderate blood loss (higher in elective cesarean section), neonatal transfer to NICU and neonatal infections (both higher in planned vaginal delivery) differed significantly.
Most studied adverse outcomes increased with increasing maternal age, as did operative delivery. Although emergency operative procedures were associated with an increased risk of adverse outcomes, the absolute risk difference in complications between the modes of delivery was low for the majority of outcomes studied.
分娩时的产妇年龄和剖宫产率都在上升。在年龄较大的女性中，分娩方式的决策可能会受到报道称随着产妇年龄增加分娩期间手术干预风险和并发症增加的影响。我们研究了低风险初产妇的产妇年龄与不良结局之间的关联，以及≥35岁女性中计划和实施的分娩方式（择期和急诊剖宫产、产钳助产分娩及自然阴道分娩）导致不良结局的风险。
利用挪威医疗出生登记处和挪威统计局的数据进行了一项基于人群的登记研究，纳入了1999年至2009年期间169,583例孕周≥37周、单胎头位分娩的低风险初产妇。研究的结局包括产科失血、产妇转入重症监护病房、5分钟Apgar评分和新生儿并发症。我们使用相对风险模型和多项逻辑回归对潜在混杂因素进行了校正。
大多数不良结局随着产妇年龄的增加而增加。然而，除了中度产科失血和转入新生儿重症监护病房（NICU）外，绝对风险的增加幅度较小。手术分娩随着产妇年龄的增加而增加，在≥35岁的女性中，手术分娩时产妇并发症的风险增加。新生儿不良结局主要在急诊手术分娩中增加。择期和急诊剖宫产发生中度失血的可能性是自然阴道分娩的三倍，产钳助产分娩的可能性是自然阴道分娩的两倍。急诊手术分娩时低Apgar评分和新生儿并发症的发生率是自然阴道分娩的两到三倍。然而，比较择期剖宫产后和计划阴道分娩后的结局，只有中度失血（择期剖宫产中更高）、新生儿转入NICU和新生儿感染（计划阴道分娩中均更高）有显著差异。
大多数研究的不良结局随着产妇年龄的增加而增加，手术分娩也是如此。尽管急诊手术操作与不良结局风险增加有关，但对于大多数研究的结局而言，不同分娩方式之间并发症的绝对风险差异较小。
