Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Matern Fetal Neonatal Med. 2021 Apr;34(8):1183-1189. doi: 10.1080/14767058.2019.1627319. Epub 2019 Jun 11.
To evaluate the impact of mode of delivery on the outcome of neonates born before 34 weeks of gestation.
This is a retrospective cohort study of all singleton live neonates born between 24.1 and 34.0 weeks of gestation at our institute between January 2009 and July 2017. Maternal and pregnancy characteristics, as well as the neonatal outcome, were compared between vaginal delivery (VD) and cesarean delivery (CD).
Of 475 preterm births, 223 (46.9%) were delivered vaginally and 252 (53.1%) were delivered by CD. Women who delivered vaginally were younger, (29.6 ± 6 versus 31.2 ± 6 years, = .003), had lower rate of hypertensive disorders (9.9 versus 36.1%, < .001), and diabetes mellitus (0.4 versus 4.4%, = .006), and had higher rate of drug abuse (4.9 versus 1.6%, = .006), as compared to those who delivered by CD. Neonates who were born by VD had higher birth weight (1716 ± 595 versus 1443 ± 507, < .001) and a lower rate of Small for gestational age (7.2 versus 19.4%, < .001) than those who were born by CD. Although VD neonates had higher Apgar score, as compared with CD, the neonatal composite outcome was similar between the two modes of deliveries. These findings were consistent in subgroups analysis according to gestational age (GA). By logistic regression analysis, only the administration of betamethasone up to 1 week prior to delivery (aOR = 0.59, 95% CI 0.38-0.92, = .001) and GA at delivery (aOR = 0.74 95% CI 0.64-0.84, = .004) were found to be independently protective against composite neonatal outcome.
It seems that neonatal outcome is not affected by the mode of delivery.
评估分娩方式对 34 周前出生的新生儿结局的影响。
这是一项回顾性队列研究，纳入了 2009 年 1 月至 2017 年 7 月期间在我院出生胎龄为 24.1 至 34.0 周的所有单胎活产儿。比较阴道分娩（VD）与剖宫产（CD）的产妇和妊娠特征以及新生儿结局。
在 475 例早产中，223 例（46.9%）经阴道分娩，252 例（53.1%）经 CD 分娩。与 CD 分娩相比，阴道分娩产妇更年轻（29.6±6 岁与 31.2±6 岁，=0.003），高血压疾病发生率更低（9.9%与 36.1%，<0.001），糖尿病发生率更低（0.4%与 4.4%，=0.006），药物滥用发生率更高（4.9%与 1.6%，=0.006）。VD 分娩新生儿出生体重更高（1716±595 克与 1443±507 克，<0.001），小于胎龄儿发生率更低（7.2%与 19.4%，<0.001）。尽管 VD 新生儿的 Apgar 评分高于 CD 分娩，但两种分娩方式的新生儿复合结局相似。根据胎龄（GA）进行亚组分析，这些发现是一致的。通过逻辑回归分析，仅发现分娩前 1 周内使用倍他米松（aOR=0.59，95%CI 0.38-0.92，=0.001）和分娩时 GA（aOR=0.74，95%CI 0.64-0.84，=0.004）是新生儿复合结局的独立保护因素。
似乎分娩方式并不影响新生儿结局。
