AlQurashi Mansour A
Neonatology Division, Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2020 Dec 5;12(12):e11918. doi: 10.7759/cureus.11918.
Worldwide cesarean birth had increased over the past three decades and in the USA, the overall rate of cesarean birth has increased from 23.8% in 1989 to 31.9% in 2018. Moreover, the substantial increase of preterm infants delivered by cesarean section had reached anywhere from 45% to 72% for gestational age <33 weeks. There is a considerable debate on whether cesarean section confers a survival advantage for preterm infants. Published data on the relationship between mode of delivery and survival rate were inconsistent and there is a lack of large randomized controlled trials (RCTs) that have investigated this important clinical concern. Thus, the aim of this study is to evaluate the impact of cesarean section on the survival rate of very low birth weight (VLBW) infants.
This was a retrospective cohort study of ≤32 weeks VLBW infants born alive and admitted to Neonatal Intensive Care Unit (NICU) at King Abdulaziz Medical City-Jeddah (KAMC-Jeddah) between January 1, 1994, and December 31, 2019. The primary outcome of interest was the survival rate to discharge of VLBW infants delivered by cesarean section compared to delivered vaginally. Relevant demographic and clinical variables were assessed and its association to survival to discharge of VLBW infants were analyzed.
Of the 1055 ≤32 weeks VLBW infants included in the study, 559 (53%) were delivered by cesarean section, and 496 (47%) were delivered vaginally. Cesarean delivery had increased from 44.2% to 66% between 1994-1998 and 2014-2019, respectively. The rise of cesarean delivery compared with the vaginal delivery was more profound for gestational age ≤26 weeks and birth weight ≤800 g. The VLBW infants delivered by cesarean section had a higher survival rate when compared to infants delivered vaginally (87.29% vs 71.77%, P<0.001). The survival advantage was statistically significant in extremely low birth weight (ELBW) infants (801-1000 g) and infants with birth weight ≤800 g, 86.73% vs 73.62%, P=0.018 and 58.02% vs 40.52, P=0.001, respectively. Moreover, VLBW infants ≤26 weeks gestational age delivered by cesarean section had a higher survival rate of 69.15% vs 44.5%, P<0.001.
This study demonstrates that cesarean birth is associated with higher survival for VLBW infants with birth weight ≤800 g and ELBW infants and gestational age ≤26 weeks compared to vaginal birth.
在过去三十年中，全球剖宫产率有所上升，在美国，剖宫产的总体比率已从1989年的23.8%增至2018年的31.9%。此外，孕周小于33周的早产儿通过剖宫产分娩的大幅增加幅度在45%至72%之间。剖宫产是否能为早产儿带来生存优势存在相当大的争议。已发表的关于分娩方式与生存率之间关系的数据并不一致，且缺乏大型随机对照试验（RCT）来研究这一重要的临床问题。因此，本研究的目的是评估剖宫产对极低出生体重（VLBW）婴儿生存率的影响。
这是一项回顾性队列研究，研究对象为1994年1月1日至2019年12月31日期间在吉达阿卜杜勒阿齐兹国王医疗城（KAMC-Jeddah）出生并入住新生儿重症监护病房（NICU）的孕周≤32周的存活VLBW婴儿。主要关注的结果是剖宫产分娩的VLBW婴儿与经阴道分娩的VLBW婴儿出院时的生存率。评估了相关的人口统计学和临床变量，并分析了其与VLBW婴儿出院生存率的关联。
在纳入研究的1055例孕周≤32周的VLBW婴儿中，559例（53%）通过剖宫产分娩，496例（47%）经阴道分娩。剖宫产率在1994 - 1998年至2014 - 2019年期间分别从44.2%增至66%。与阴道分娩相比，剖宫产率的上升在孕周≤26周和出生体重≤800 g的婴儿中更为显著。与经阴道分娩的婴儿相比，剖宫产分娩的VLBW婴儿生存率更高（87.29%对71.77%，P<0.001）。在极低出生体重（ELBW）婴儿（801 - 1000 g）和出生体重≤800 g的婴儿中，生存优势具有统计学意义，分别为86.73%对73.62%，P = 0.018以及58.02%对40.52%，P = 0.001。此外，孕周≤26周的剖宫产VLBW婴儿生存率更高，为69.15%对44.5%，P<0.001。
本研究表明，与阴道分娩相比，剖宫产与出生体重≤800 g的VLBW婴儿、ELBW婴儿以及孕周≤26周的婴儿更高的生存率相关。
