Oregon Health & Science University, Portland, OR, USA.
J Matern Fetal Neonatal Med. 2020 Oct;33(20):3391-3398. doi: 10.1080/14767058.2019.1572740. Epub 2019 Mar 18.
Prior research has found that women with disabilities are more likely to deliver by cesarean than are women without disabilities. It is not clear whether all of the cesarean deliveries among women with disabilities are medically necessary. To examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries. Retrospective cohort study of all nulliparous births in California between 2000 and 2012. We classified births as to whether or not women underwent a trial of labor and determined if medical indications for cesarean delivery were present. Multivariable logistic regression models examined the association of disability with trial of labor and indications for cesarean delivery. Women with disabilities had lower odds of having a labored delivery, compared to women without disabilities (adjusted odds ratio (aOR) = 0.45, 95% confidence interval (CI) 0.41-0.49). In the sample of women who labored (90.5% of total), women with disabilities were more likely to have a medical indication for cesarean delivery (aOR = 1.15, 95% CI 1.10-1.21) and were more likely to have a cesarean delivery (aOR = 1.46, 95% CI = 1.38-1.54). In the subsample of unlabored cesarean deliveries, women with disabilities were less likely to have documented medical indications for cesarean delivery (aOR = 0.45, 95% CI = 0.41-0.50). Women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.
先前的研究发现，残疾女性比非残疾女性更有可能通过剖腹产分娩。目前尚不清楚残疾女性所有的剖腹产是否都有医学必要性。本研究旨在探讨加利福尼亚州分娩中产妇残疾状况与分娩方式和剖腹产医学指征之间的关系。这是一项对 2000 年至 2012 年间加利福尼亚州所有初产妇的回顾性队列研究。我们将分娩分为是否经历了试产，并确定是否存在剖腹产的医学指征。多变量逻辑回归模型分析了残疾与试产和剖腹产指征之间的关联。与非残疾女性相比，残疾女性进行试产的可能性较低（校正优势比[aOR] = 0.45，95%置信区间[CI]为 0.41-0.49）。在进行试产的女性样本中（占总样本的 90.5%），残疾女性更有可能存在剖腹产的医学指征（aOR = 1.15，95%CI 为 1.10-1.21），且更有可能行剖腹产（aOR = 1.46，95%CI 为 1.38-1.54）。在未试产的剖腹产样本中，残疾女性更有可能没有记录剖腹产的医学指征（aOR = 0.45，95%CI 为 0.41-0.50）。与非残疾女性相比，残疾女性进行试产的可能性较低，且这些未试产的剖腹产更不可能存在剖腹产的医学指征。
