多产妇、足月、单胎、头位剖宫产的人群风险因素：一项全国性的横断面研究。

Population risk factors for nulliparous, term, singleton, vertex caesarean birth: a national cross-sectional study.

机构信息

Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.

出版信息

BJOG. 2021 Aug;128(9):1456-1463. doi: 10.1111/1471-0528.16684. Epub 2021 Apr 6.

DOI:10.1111/1471-0528.16684

PMID:33660911

Abstract

OBJECTIVE

To characterise medical, obstetric and demographic risk factors associated with nulliparous, term, singleton, vertex (NTSV) caesarean birth.

STUDY DESIGN

Cross-sectional study.

SETTING

United States delivery hospitalisations.

POPULATION

NTSV births in 2016-18 US natality data.

METHODS

This study analysed a national sample of natality data generated by the United States National Vital Statistics System. NTSV deliveries were identified. The primary outcome was caesarean birth. Risk factors including maternal age, body mass index (BMI) and pregestational diabetes were analysed. Multivariable log-linear regression models analysed factors associated with NTSV caesarean with adjusted risk ratios (aRR) as measures of effect.

RESULTS

Of 11 622 400 deliveries, 3 764 707 met NTSV criteria, and their caesarean section rate was 25.9%. Maternal age 35-39 years (aRR 1.51, 95% CI 1.50-1.52) and 40-54 years (aRR 2.03, 95% 2.00-2.05) compared with age 19-34 years; BMI 25 to <30 kg/m2 (aRR 1.32, 95% CI 1.31-1.33), 30 to <35 kg/m2 (aRR 1.57 95% CI 1.56-1.58), 35 to <40 kg/m2 (aRR 1.82, 95% CI 1.80-1.83) and ≥40 kg/m2 (aRR 2.17, 95% CI 2.15-2.19) compared with BMI 18.5-24.9 kg/m2; and pregestational diabetes (aRR 1.54, 95% CI 1.51-1.57) were all associated with increased risk. Risk factors allowed stratification of patients into high-risk versus low-risk groups. The NTSV caesarean rate was 37.9% in women who had one or more of the following characteristics: age ≥35 years, BMI ≥30 kg/m2 or pregestational diabetes. In comparison, the NTSV caesarean rate was 20.8% among women without any of these three risk factors (P < 0.01).

CONCLUSION

Among NTSV births, BMI, maternal age and medical conditions are important risk factors for caesarean delivery.

摘要

目的

描述与初产妇、足月、单胎、头位（NTSV）剖宫产相关的医学、产科和人口统计学危险因素。

研究设计

横断面研究。

设置

美国分娩医院。

人群

2016-18 年美国出生率数据中的 NTSV 分娩。

方法

本研究分析了美国国家生命统计系统生成的全国出生率数据的一个样本。确定了 NTSV 分娩。主要结局是剖宫产。分析了包括产妇年龄、体重指数（BMI）和孕前糖尿病在内的危险因素。多变量线性回归模型分析了与 NTSV 剖宫产相关的因素，并以调整后的风险比（aRR）作为效应衡量标准。

结果

在 11622400 例分娩中，有 3764707 例符合 NTSV 标准，其剖宫产率为 25.9%。与 19-34 岁年龄组相比，35-39 岁（aRR 1.51，95%CI 1.50-1.52）和 40-54 岁（aRR 2.03，95%CI 2.00-2.05）；BMI 25 至<30kg/m2（aRR 1.32，95%CI 1.31-1.33）、30 至<35kg/m2（aRR 1.57 95%CI 1.56-1.58）、35 至<40kg/m2（aRR 1.82，95%CI 1.80-1.83）和≥40kg/m2（aRR 2.17，95%CI 2.15-2.19）与 BMI 18.5-24.9kg/m2 相比；以及孕前糖尿病（aRR 1.54，95%CI 1.51-1.57）均与风险增加相关。危险因素允许将患者分层为高风险组和低风险组。在有以下一种或多种特征的女性中，NTSV 剖宫产率为 37.9%：年龄≥35 岁、BMI≥30kg/m2 或孕前糖尿病。相比之下，在没有这三种危险因素的女性中，NTSV 剖宫产率为 20.8%（P<0.01）。