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哥伦比亚波哥大一家高复杂度诊所剖宫产分娩新生儿住院风险,2018 年。

RISK OF NEONATAL HOSPITALIZATION ASSOCIATED TO DELIVERY BY CESAREAN SECTION IN A HIGH COMPLEXITY CLINIC IN BOGOTÁ, COLOMBIA, 2018.

机构信息

Especialista en Obstetricia y Ginecología, Universidad Nacional de Colombia. Bogotá, Colombia.

Especialista en Obstetricia y Ginecología. Jefe médico del servicio de Ginecobstetricia, Clínica Juan N. Corpas. Bogotá, Colombia.

出版信息

Rev Colomb Obstet Ginecol. 2020 Mar;71(1):42-55. doi: 10.18597/rcog.3364.

Abstract

OBJECTIVE

To evaluate the association between cesarean delivery and hospitalization of the newborn and describe the indications for cesarean according to Robson's groups in the obstetrics service of a highly complex general institution.

METHODS

Cross-sectional study. All births occurred between March and July 2018 in a high complexity general teaching hospital in Bogotá, Colombia were included, by consecutive sampling up to a sample size of 1040 pregnant women. The frequency of caesarean section, indications, neonatal outcomes for each Robson group, and the risk of neonatal hospitalization are described using the crude and adjusted odds ratio (OR) using multivariate analysis.

RESULTS

1,493 births were included, of which 539 (36.3 %) were by cesarean section. Women with a history of uterine scar scheduled for elective caesarean section and those hospitalized for induction provide the majority of caesarean sections. The main indications for cesarean section were suspicion of unsatisfactory fetal status and prolongued labor. Adjusted for birth weight, caesarean section increased the overall risk of neonatal hospitalization (adjusted OR [aOR] = 2,2; IC 99 %: 1,3-3,7).

CONCLUSIONS

There are groups of Robson susceptible of intervention to decrease the rate of caesarean sections due to the suspicion of unsatisfactory fetal status and prolongation of labor. An association was found between cesarean delivery and subsequent neonatal hospitalization. Randomized controlled studies are required to determine the benefit of the strategies to reduce cesarean section rates and evaluate the association found.

摘要

目的

评估剖宫产分娩与新生儿住院之间的关联,并根据 Robson 分组描述高度复杂综合机构产科服务中的剖宫产指征。

方法

横断面研究。纳入 2018 年 3 月至 7 月期间在哥伦比亚波哥大一家高度复杂的综合教学医院发生的所有分娩,采用连续抽样,直至样本量达到 1040 名孕妇。描述每个 Robson 组的剖宫产率、指征、新生儿结局以及新生儿住院的风险,使用多变量分析描述粗比值比(OR)和调整比值比(aOR)。

结果

共纳入 1493 例分娩,其中 539 例(36.3%)为剖宫产。因子宫瘢痕史择期行剖宫产和因引产住院的妇女是剖宫产的主要人群。剖宫产的主要指征是怀疑胎儿情况不佳和产程延长。调整出生体重后,剖宫产增加了新生儿整体住院的风险(调整 OR [aOR] = 2.2;99%CI:1.3-3.7)。

结论

存在一些 Robson 组易受干预措施影响,以降低因怀疑胎儿情况不佳和产程延长而行剖宫产的比率。发现剖宫产分娩与随后的新生儿住院之间存在关联。需要开展随机对照研究来确定降低剖宫产率的策略的获益,并评估所发现的关联。

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