Tefera Maleda, Assefa Nega, Mengistie Bezatu, Abrham Aklilu, Teji Kedir, Worku Teshager
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Front Pediatr. 2020 Jun 25;8:286. doi: 10.3389/fped.2020.00286. eCollection 2020.
Cesarean section (CS) is one of the most recurrently carried out surgical procedures in modern obstetrics. Worldwide, about 18.5 million CSs are conducted annually. Of this, 21-33% are performed in middle-and high-income countries. The effectiveness of the CS in preventing maternal and prenatal mortality and morbidity is medically justifiable. However, cesarean delivery without demanding obstetrical indications, by mere maternal request, may expose the child to several risks over benefits. Therefore, we aim to compare spontaneous vaginal delivery (vaginal delivery other than operative vaginal deliveries) and elective CS (CS before the onset of labor, but not including emergency CS) in decreasing the risk of neonatal respiratory morbidity. To compare the risk of neonatal respiratory morbidity in ECS and spontaneous vaginal delivery. A literature search was performed through visiting an electronic database (MEDLINE, PubMed, EMBASE, and CINAHL) and gray literature sources, including Google and Google Scholar, from January 2000 to May 2018. Original observational studies that reported the risk of neonatal respiratory morbidity in relation to mode of delivery conducted in the English language were identified and screened. Joanna Briggs Institute's quality assessment tool for observational studies was used to critically appraise the methodological quality of studies. Synthesis of individual studies was conducted using the Review Manager Software version 5.3 for Windows. Heterogeneity among studies was explored using the Cochran's -test and the statistics. Pooled effect sizes in relative risk ratios with 95% confidence intervals were calculated. The flow of the study was prepared according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Sixteen studies were reviewed. A total of 327,272 neonates born by vaginal delivery and 55,246 born by ECS were included in this study. The risk of neonatal respiratory morbidity was increased by 95% in neonates delivered by ECS ( = 1.95; 95% CI: 1.40-2.73) as compared with neonates born by spontaneous vaginal delivery. This study investigated the effect of mode of delivery on the respiratory morbidity without considering other risks and found that the ECS has a high risk of developing neonatal respiratory morbidities when compared to spontaneous vaginal delivery. So, we recommend discouraging unnecessary CS. : CRD42018104905.
剖宫产（CS）是现代产科中最常施行的外科手术之一。在全球范围内，每年约有1850万例剖宫产手术。其中，21% - 33%在中高收入国家进行。剖宫产在预防孕产妇和围产儿死亡率及发病率方面的有效性在医学上是合理的。然而，仅因产妇要求而进行无产科指征的剖宫产，可能使胎儿面临的风险超过益处。因此，我们旨在比较自然阴道分娩（非手术助产的阴道分娩）和择期剖宫产（临产前的剖宫产，但不包括急诊剖宫产）在降低新生儿呼吸系统发病率风险方面的差异。为比较择期剖宫产和自然阴道分娩中新生儿呼吸系统发病的风险。通过访问电子数据库（MEDLINE、PubMed、EMBASE和CINAHL）以及灰色文献来源（包括谷歌和谷歌学术），对2000年1月至2018年5月的文献进行检索。筛选出以英文发表的、报告了与分娩方式相关的新生儿呼吸系统发病风险的原始观察性研究。使用乔安娜·布里格斯研究所的观察性研究质量评估工具对研究的方法学质量进行严格评估。使用适用于Windows的Review Manager软件版本5.3对个体研究进行综合分析。使用 Cochr an's Q检验和I²统计量探索研究间的异质性。计算相对风险比及95%置信区间的合并效应量。根据流行病学观察性研究的Meta分析（MOOSE）清单编制研究流程。共审查了16项研究。本研究纳入了327272例经阴道分娩的新生儿和55246例经择期剖宫产分娩的新生儿。与自然阴道分娩的新生儿相比，择期剖宫产分娩的新生儿呼吸系统发病风险增加了95%（RR = 1.95；95% CI：1.40 - 2.73）。本研究在未考虑其他风险的情况下调查了分娩方式对呼吸系统发病的影响，发现与自然阴道分娩相比，择期剖宫产有较高的新生儿呼吸系统发病风险。因此，我们建议不鼓励进行不必要的剖宫产。登记号：CRD42018104905
