产妇年龄对初产妇自然分娩时剖宫产率的影响。
Impact of maternal age on intrapartum caesarean delivery rate in nulliparas with spontaneous labour.
作者信息
Crequit Simon, Korb Diane, Schmitz Thomas, Morin Cécile, Sibony Olivier
机构信息
Department of Gynecology and Obstetrics, Robert Debré University Hospital, AP-HP, Paris, France.
Department of Gynecology and Obstetrics, Robert Debré University Hospital, AP-HP, Paris, France; INSERM U1153, EPOPé Team, Paris, France.
出版信息
J Gynecol Obstet Hum Reprod. 2019 Jun;48(6):407-411. doi: 10.1016/j.jogoh.2019.02.008. Epub 2019 Feb 21.
BACKGROUND
The advanced maternal age rate increases in developed countries. Older women have more pre-existing condition than youngest women and develop more frequently obstetrical pathologies responsible for a higher rate of caesarean delivery before labour and labour induction. For aged nulliparous without pathology who experience spontaneous labour, there is few data on the mode of delivery and on physiological labour according to maternal age.
OBJECTIVE
To compare the intrapartum caesarean delivery rate according to maternal age, for nulliparous with planned vaginal delivery and spontaneous labour at term.
METHODS
Retrospective cohort in a single academic institution between January 2000 and June 2017. All nulliparous women with planned vaginal delivery with live singleton in cephalic presentation at and after 37 weeks of gestation with spontaneous labour were included (n = 10,611). Two groups were compared: nulliparous women aged 20-34 and nulliparous women aged 35 and over. The main outcome was the intrapartum caesarean delivery rate. A subgroup analysis was performed for nulliparous with more advanced maternal age defined as women over 40.
RESULTS
Among the 10,611 women included in this analysis, 8,993 (84.8%) were aged 20-34 and 1,618 (15.2%) were aged over 35. From the latter 367 (22.7%) were over 40 years old. The intrapartum caesarean delivery rate was similar between women aged between 20 and 34 and women aged over 35 (10.8% compared to 8.8%; cOR 0.91, 95% CI 0.76-1.08; aOR 0.91, 95% CI 0.76-1.09). The indications of caesarean were similar in both groups. No differences were found between both groups for mean labour duration (430.9 min for the [20-34] years group compared to 428.0 min for the over 35 years group, p = 0.654). The subgroup analysis performed on nulliparous with more advanced maternal age yielded similar results.
CONCLUSION
For nulliparous at term in spontaneous labour, an advanced maternal age was not associated with an increased intrapartum caesarean delivery rate.
背景
发达国家高龄产妇的比例在上升。年龄较大的女性比最年轻的女性有更多的基础疾病，并且更频繁地出现产科病理情况，这导致了更高的临产前剖宫产率和引产率。对于无病理情况且自然分娩的高龄初产妇，关于分娩方式和根据产妇年龄的生理分娩的数据很少。
目的
比较足月计划阴道分娩且自然分娩的初产妇中，不同产妇年龄的产时剖宫产率。
方法
对2000年1月至2017年6月期间在单一学术机构进行的回顾性队列研究。纳入所有妊娠37周及以后计划阴道分娩、单胎活产、头先露且自然分娩的初产妇（n = 10611）。比较两组：20 - 34岁的初产妇和35岁及以上的初产妇。主要结局是产时剖宫产率。对年龄更大的初产妇（定义为40岁以上的女性）进行亚组分析。
结果
在本分析纳入的10611名女性中，8993名（84.8%）年龄在20 - 34岁，1618名（15.2%）年龄在35岁以上。在后者中，367名（22.7%）年龄超过40岁。20至34岁的女性与35岁以上的女性产时剖宫产率相似（分别为10.8%和8.8%；校正比值比0.91，95%可信区间0.76 - 1.08；调整后比值比0.91，95%可信区间0.76 - 1.09）。两组剖宫产指征相似。两组平均产程无差异（20 - 34岁组为430.9分钟，35岁以上组为428.0分钟，p = 0.654）。对年龄更大的初产妇进行的亚组分析得出了相似的结果。
结论
对于足月自然分娩的初产妇，高龄产妇与产时剖宫产率增加无关。
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