School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.
Birth. 2022 Dec;49(4):812-822. doi: 10.1111/birt.12654. Epub 2022 Jun 13.
There is widespread concern around the rising rates of cesarean births (CBs), especially among first-time mothers, despite evidence suggesting increased morbidities after birth by cesarean. There are uncertainties around factors associated with rising rates of CBs among first-time mothers in Ireland, and insight into these is essential for understanding the rising trend in CBs. Therefore, this study aimed to identify the factors associated with CBs in nulliparous women.
A prospective cohort study was conducted in three maternity hospitals in the Republic of Ireland between 2012 and 2017. Data were collected from 3047 nulliparous women using self-administered surveys antenatally and at 3 months postpartum and from consenting women's hospital records (n = 2755) and analyzed using the Poisson regression to assess associations between demographic and clinical factors and the main outcome measures, planned and unplanned CBs.
Common risk factors for planned and unplanned CBs were being aged ≥40 years, being in private care, multiple pregnancy, and fetus in breech or other malpresentations. An unplanned CB occurred for 22.43% (n = 377/1681) of women who did not have induction of labor (IOL) or who had IOL with no epidural, but the risk was about twice as high for women who had IOL and epidural.
Findings confirm multifactorial reasons for CB and the challenge of reversing the increasing CB rate if maternal age, overweight/obesity, infertility treatment, multiple pregnancy, and preexisting hypertension in Ireland continue to increase. There is a need to address prelabor interventions, especially IOL combined with epidural analgesia with respect to unplanned CB.
尽管有证据表明剖宫产（CB）后出生的发病率增加，但由于人们对爱尔兰初产妇 CB 率上升的相关因素存在广泛担忧，因此了解这些因素对于理解 CB 上升趋势至关重要。因此，本研究旨在确定与初产妇 CB 相关的因素。
2012 年至 2017 年，在爱尔兰共和国的三家产科医院进行了一项前瞻性队列研究。通过产前和产后 3 个月的自我管理问卷调查，收集了 3047 名初产妇的数据，并从同意的女性医院记录中收集了数据（n=2755），使用泊松回归分析评估了人口统计学和临床因素与主要结局指标（计划性和非计划性 CB）之间的关联。
计划性和非计划性 CB 的常见危险因素为年龄≥40 岁、私人护理、多胎妊娠和胎儿臀位或其他异常位置。未行引产（IOL）或 IOL 无硬膜外麻醉的妇女中，22.43%（n=377/1681）发生了非计划性 CB，但行 IOL 联合硬膜外麻醉的妇女风险约为前者的两倍。
研究结果证实了 CB 的多因素原因，如果爱尔兰的产妇年龄、超重/肥胖、不孕治疗、多胎妊娠和既往高血压继续增加，逆转 CB 率上升的挑战仍然存在。有必要针对产前干预措施，特别是 IOL 联合硬膜外镇痛与非计划性 CB 进行干预。
