Adams Nicole, Gibbons Kristen S, Tudehope David
The School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Mater Research Office, Mater Research, South Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):176-185. doi: 10.1111/ajo.12591. Epub 2017 Mar 22.
Prelabour caesarean section (CS) at early term (37 -38 weeks) is associated with higher rates of adverse short-term neonatal outcomes and higher costs than those performed at full term (39 -40 weeks). Prelabour CS is more common in private than in public hospitals in Australia, particularly at early term.
To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term.
A retrospective cohort study of 22 954 viable singleton prelabour CS births at term (37 -40 weeks) at a single centre encompassing co-located public and private hospitals during 1998-2013 was undertaken. Propensity score analysis was used to adjust for confounding differences between sectors. The primary outcome was Neonatal Critical Care Unit (NCCU) admission with serious morbidity. Secondary outcomes included respiratory distress, vigorous resuscitation and jaundice.
The private hospital performed prelabour CS at over double the rate of the public hospital (33.7% of all private births vs 14.7% public) and more private than public prelabour CSs occurred at early term (66.8% vs 47.9%). Public babies were more than twice as likely as private babies to require admission to NCCU with serious morbidity (adjusted odds ratio (AOR) 2.54, 95% CI 1.77-3.65) but were less likely to need vigorous resuscitation (AOR 0.53, 95% CI 0.45-0.62). Disparities in outcomes between public and private cohorts were accentuated at full term.
Despite early-term prelabour CSs occurring more often in the private hospital, public babies had more adverse outcomes and treatment escalations.
早产剖宫产（CS）在孕早期（37 - 38周）进行时，与足月（39 - 40周）进行相比，短期新生儿不良结局发生率更高且成本更高。在澳大利亚，早产剖宫产在私立医院比公立医院更常见，尤其是在孕早期。
评估医院类型（公立或私立）以及分娩时间对足月早产剖宫产术后短期新生儿结局的影响。
对1998 - 2013年期间在一个包含同地公立和私立医院的单一中心进行的22954例足月（37 - 40周）存活单胎早产剖宫产分娩进行回顾性队列研究。采用倾向得分分析来调整不同医院类型之间的混杂差异。主要结局是因严重疾病入住新生儿重症监护病房（NCCU）。次要结局包括呼吸窘迫、强力复苏和黄疸。
私立医院进行早产剖宫产的比例是公立医院的两倍多（占所有私立分娩的33.7%，而公立医院为14.7%），且私立医院早产剖宫产在孕早期的发生率高于公立医院（66.8%对47.9%）。公立分娩的婴儿因严重疾病入住NCCU的可能性是私立分娩婴儿的两倍多（调整优势比（AOR）2.54，95%置信区间1.77 - 3.65），但需要强力复苏的可能性较小（AOR 0.53，95%置信区间0.45 - 0.62）。足月时，公立和私立队列之间的结局差异更为明显。
尽管私立医院孕早期早产剖宫产更为常见，但公立分娩的婴儿不良结局和治疗升级情况更多。
