Bachilova Sophia, Czuzoj-Shulman Nicholas, Abenhaim Haim Arie
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC.
Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montréal, QC.
J Obstet Gynaecol Can. 2018 May;40(5):540-546. doi: 10.1016/j.jogc.2017.07.029. Epub 2017 Nov 10.
The prevalence of home birth in the United States is increasing, although its safety is undetermined. The objective of this study was to investigate the effects of obstetrical risk factors on early neonatal death in planned home births delivering at home.
The authors conducted a retrospective 3-year cohort study consisting of planned home births that delivered at home in the United States between 2011 and 2013. The study excluded infants with congenital and chromosomal anomalies and infants born at ≤34 weeks' gestation. Multivariate logistic regression models were used to estimate the adjusted effects of individual obstetrical variables on early neonatal deaths within 7 days of delivery.
During the study period, there were 71 704 planned and delivered home births. The overall early neonatal death rate was 1.5 deaths per 1000 planned home births. The risks of early neonatal death were significantly higher in nulliparous births (OR 2.71; 95% CI 1.71-4.31), women with a previous CS (OR 2.62, 95% CI 1.25-5.52), non-vertex presentations (OR 4.27; 95% CI 1.33-13.75), plural births (OR 9.79; 95% CI 4.25-22.57), preterm births (OR 4.68; 95% CI 2.30-9.51), and births at ≥41 weeks of gestation (OR 1.76; 95% CI 1.09-2.84).
Early neonatal deaths occur more commonly in certain obstetrical contexts. Patient selection may reduce adverse neonatal outcomes among planned home births.
在美国，家庭分娩的发生率正在上升，但其安全性尚未确定。本研究的目的是调查产科风险因素对在家中进行的计划内家庭分娩中早期新生儿死亡的影响。
作者进行了一项为期3年的回顾性队列研究，研究对象为2011年至2013年在美国在家中进行的计划内家庭分娩。该研究排除了患有先天性和染色体异常的婴儿以及孕周≤34周出生的婴儿。采用多变量逻辑回归模型来估计各个产科变量对分娩后7天内早期新生儿死亡的校正影响。
在研究期间，共有71704例计划内并在家中分娩的案例。早期新生儿总体死亡率为每1000例计划内家庭分娩中有1.5例死亡。初产妇（比值比2.71；95%置信区间1.71 - 4.31）、有剖宫产史的女性（比值比2.62，95%置信区间1.25 - 5.52）、非头位分娩（比值比4.27；95%置信区间1.33 - 13.75）、多胎分娩（比值比9.79；95%置信区间4.25 - 22.57）、早产（比值比4.68；95%置信区间2.30 - 9.51）以及孕周≥41周的分娩（比值比1.76；95%置信区间1.09 - 2.84）中，早期新生儿死亡风险显著更高。
早期新生儿死亡在某些产科情况下更为常见。患者选择可能会降低计划内家庭分娩中不良新生儿结局的发生率。
