Vaajala Matias, Liukkonen Rasmus, Kuitunen Ilari, Ponkilainen Ville, Mattila Ville M, Kekki Maiju
Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.
Birth. 2025 Mar;52(1):123-128. doi: 10.1111/birt.12869. Epub 2024 Aug 30.
The aim of this study was to evaluate the association between previous major traumas and the prevalence of fear of childbirth (FOC) and the subsequent effects of FOC on the intended mode of delivery.
In this nationwide retrospective register-based cohort study, data from the Care Register for Health Care were linked with the National Medical Birth Register (MBR) to evaluate the prevalence of FOC after major traumas. A total of 18,573 pregnancies met the inclusion criteria. A multivariable logistic regression model was used to assess the effects of FOC on the intended mode of delivery. Women with major traumas before pregnancy were compared to individuals with wrist fractures. Adjusted odds ratios (aORs) with 95% CIs between the groups were compared.
Of those pregnancies that occurred after major traumas, 785 (6.2%) women were diagnosed with FOC after traumatic brain injury (TBI), 111 (6.1%) women after spine fracture, 38 (5.0%) women after pelvic fracture, 22 (3.2%) women after hip or thigh fracture, and 399 (5.2%) women in the control group. Among those women diagnosed with FOC, the adjusted odds for elective CB as an intended mode of delivery were highest among women with previous spine fractures (aOR 2.28, CI 1.45-3.60) when compared to the control group.
We found no evidence of differences in maternal FOC in patients with preceding major traumas when compared to the control group. Therefore, it seems highly likely that the major trauma itself is the explanatory factor for the increased rate of elective CB.
本研究旨在评估既往重大创伤与分娩恐惧（FOC）患病率之间的关联，以及FOC对预期分娩方式的后续影响。
在这项基于全国性回顾性登记的队列研究中，将医疗保健护理登记册中的数据与国家医疗出生登记册（MBR）相链接，以评估重大创伤后FOC的患病率。共有18573例妊娠符合纳入标准。采用多变量逻辑回归模型评估FOC对预期分娩方式的影响。将孕前有重大创伤的女性与手腕骨折的个体进行比较。比较两组之间的调整优势比（aORs）及其95%可信区间（CIs）。
在重大创伤后发生的妊娠中，785例（6.2%）女性在创伤性脑损伤（TBI）后被诊断为FOC，111例（6.1%）女性在脊柱骨折后被诊断为FOC，38例（5.0%）女性在骨盆骨折后被诊断为FOC，22例（3.2%）女性在髋部或大腿骨折后被诊断为FOC，对照组中有399例（5.2%）女性被诊断为FOC。在那些被诊断为FOC的女性中，与对照组相比，既往有脊柱骨折的女性选择剖宫产作为预期分娩方式的调整优势比最高（aOR 2.28，CI 1.45 - 3.60）。
与对照组相比，我们没有发现既往有重大创伤的患者在产妇FOC方面存在差异的证据。因此，重大创伤本身很可能是选择性剖宫产率上升的解释因素。
