Department of Gynecology and Obstetrics, Holbaek Hospital, Holbaek, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2019 Jul;98(7):905-912. doi: 10.1111/aogs.13549. Epub 2019 Feb 24.
The aim of this study was to compare short-term maternal outcomes in healthy primiparous women with uncomplicated pregnancies who delivered a singleton child at term by planned cesarean or planned vaginal delivery.
Nationwide population-based cohort study of 145 821 low-risk primiparous women with healthy singletons in cephalic position in Denmark, 2008-2016. Data from the Medical Birth Register and the Danish National Patient Registry were linked and compared according to planned mode of delivery. Main outcome measures were major morbidity including maternal death, cardiac arrest, hysterectomy and thromboembolic disease. Minor maternal morbidity includes wound infection, postpartum fever, wound rupture and reoperation, bladder lesions, spinal headache and Ogilvie syndrome. Additionally, anal sphincter injuries were registered.
The study included 141 782 planned vaginal deliveries and 4039 planned cesarean deliveries. Severe maternal complications occurred in fewer than 1/4000 in both categories. Women with planned cesarean had a slightly higher risk of wound infections (0.17% vs 0.07%; P = 0.04). There were no significant differences in the remaining minor and major outcomes. Women with planned vaginal delivery had a 4.97% risk of obstetric anal sphincter injuries.
For healthy primiparous women, both planned vaginal delivery and planned cesarean delivery are highly safe procedures when the short-term maternal outcome is taken into account. Planned cesarean delivery is associated with a slightly increased risk of wound infection compared with planned vaginal delivery. Women with planned vaginal delivery had a 4.97% risk of obstetric anal sphincter injuries.
本研究旨在比较无并发症妊娠且足月单胎头位的健康初产妇，通过计划性剖宫产或计划性阴道分娩分娩的短期母婴结局。
这是一项在丹麦进行的全国性基于人群的队列研究，纳入了 2008 年至 2016 年间的 145821 名低危初产妇，且其均为健康的头位单胎。数据来自丹麦的医疗出生登记和丹麦国家患者登记处，根据计划分娩方式进行了链接和比较。主要结局指标包括主要发病率，包括产妇死亡、心脏骤停、子宫切除术和血栓栓塞疾病。次要产妇发病率包括伤口感染、产后发热、伤口破裂和再次手术、膀胱损伤、脊椎头痛和奥吉尔维氏综合征。此外，还登记了肛门括约肌损伤。
本研究包括 141782 例计划性阴道分娩和 4039 例计划性剖宫产。两种情况下严重的产妇并发症发生率均低于 1/4000。计划性剖宫产的妇女伤口感染的风险略高（0.17% vs 0.07%；P=0.04）。其余的次要和主要结局无显著差异。计划阴道分娩的妇女发生产科肛门括约肌损伤的风险为 4.97%。
考虑短期母婴结局，对于健康的初产妇，计划性阴道分娩和计划性剖宫产均是非常安全的分娩方式。与计划性阴道分娩相比，计划性剖宫产与伤口感染风险增加略相关。计划阴道分娩的妇女发生产科肛门括约肌损伤的风险为 4.97%。
