Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia.
BMJ Open. 2019 Oct 29;9(10):e029192. doi: 10.1136/bmjopen-2019-029192.
To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home.
A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance.
All eight Australian states and territories.
Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home.
Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death).
Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth.
This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.
根据计划分娩地点（医院产房、分娩中心或家中）比较澳大利亚无并发症妊娠的围产期和产妇结局。
一项基于人群的回顾性设计，链接并分析常规收集的电子数据。分析包括分类数据的 χ 检验和二元逻辑回归，得出调整后的比值比（OR）。连续数据采用方差分析进行分析。
澳大利亚所有八个州和地区。
2000 年至 2012 年间，在 37 至 41 周足月妊娠时，头位分娩，单胎妊娠的无并发症孕妇。在 1251420 例分娩中，1171703 例（93.6%）计划在医院产房分娩，71505 例（5.7%）在分娩中心分娩，8212 例（0.7%）在家分娩。
分娩方式、正常分娩和分娩、分娩和分娩期间的干预和程序、产妇并发症、入住特殊护理/高依赖或重症监护病房（母亲或婴儿）以及围产儿死亡率（产时死胎和新生儿死亡）。
与计划在医院分娩相比，计划在分娩中心分娩的正常分娩和分娩的几率高出两倍以上（调整后的比值比（AOR）2.72；99%置信区间[CI]2.63 至 2.81），而计划在家分娩的几率几乎高出六倍（AOR 5.91；99%CI 5.15 至 6.78）。在三个计划分娩地点中，产时死胎、早期或晚期新生儿死亡的比例没有统计学上的显著差异。
这是第一项在澳大利亚范围内检查按计划分娩地点的结果的研究。对于澳大利亚健康的无并发症妊娠妇女，在分娩中心或家中计划分娩与积极的产妇结局相关，尽管总体而言家庭分娩的数量较少。围产儿死亡率没有显著差异，尽管死亡的绝对人数非常少，因此不能对围产儿死亡率的结果得出确凿的结论。
