Maternal-Infant Care Research Centre (MiCare), Mount Sinai Hospital, Toronto, ON.
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS.
J Obstet Gynaecol Can. 2022 Sep;44(9):960-971. doi: 10.1016/j.jogc.2022.04.017. Epub 2022 May 17.
To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes.
We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes.
The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women.
The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.
确定剖宫产的决定因素，并检查分娩方式与母婴围生期结局之间的关系。
我们对加拿大一个多中心出生队列进行了回顾性分析，该队列来自于 2008/2009 年收集的省级数据。比较了阴道分娩和剖宫产分娩以及以下分娩方式亚组之间的产妇和围生期特征及结局：自然阴道分娩（VD）、辅助 VD、计划剖宫产（CD）和产时 CD。多变量回归确定了剖宫产的决定因素，以及分娩方式和既往剖宫产对母婴围生期结局的影响。
该队列包括来自 91 家参与机构的 264755 例分娩（72.1%为 VD，27.9%为 CD）。剖宫产的决定因素包括产妇年龄、产次、既往剖宫产史、慢性高血压、糖尿病、尿路感染或肾盂肾炎、妊娠期高血压、阴道出血、引产、早产、低出生体重、大于胎龄儿、胎位不正和男性性别。剖宫产与母婴发病率和死亡率增加相关。亚组分析显示，辅助 VD 和产时 CD 的不良妊娠结局风险高于自然 VD。计划剖宫产降低了产科伤口血肿和围生期死亡率的风险，但增加了产妇和新生儿的发病率。既往剖宫产增加了多产妇母婴发病率的风险。
加拿大的剖宫产率与全球趋势一致，反映了人口统计学和产科干预因素。剖宫产与不良妊娠结局的风险需要评估安全预防非必要剖宫产的干预措施。
