Department of Obstetrics and Gynecology, McMaster University, 1280 Main St West, HSC 4D9, Hamilton, ON, L8S 4K1, Canada.
Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
BMC Pregnancy Childbirth. 2024 Oct 23;24(1):693. doi: 10.1186/s12884-024-06877-2.
The impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section.
Singleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section.
After chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5-13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1-18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified.
The rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section.
分娩方式对绒毛膜羊膜炎新生儿结局的影响尚不清楚。本回顾性队列研究比较了阴道分娩和剖宫产分娩的早发性新生儿败血症发生率。
纳入 2019 年 1 月 1 日至 2021 年 12 月 31 日期间大于 24+0 周妊娠、活产且临床诊断为绒毛膜羊膜炎的单胎妊娠。排除多胎妊娠、终止妊娠或单纯组织学绒毛膜羊膜炎病例。采用倾向评分加权法比较早发性新生儿败血症、选择的次要新生儿结局和产妇感染发病率的复合结局发生率。按剖宫产指征进行亚组分析。
经病历回顾，共纳入 378 例病例，其中 197 例阴道分娩，181 例剖宫产。在年龄、产次、高血压、肾脏疾病、胎龄、皮质类固醇使用、硫酸镁使用、胎粪存在和 Gibbs 标准符合率方面，两组存在差异，在倾向评分加权前。剖宫产组早发性新生儿败血症发生率较高（13.8% vs. 3.1%，调整风险差异 8.3%[3.5-13.1]，p<0.001）。两组次要新生儿结局相似。按指征比较时，与阴道分娩相比，因胎儿监护异常行剖宫产的新生儿败血症发生率较高，但因其他原因行剖宫产的新生儿败血症发生率无差异。两组次要新生儿结局调整发生率无差异。剖宫产组产妇感染发病率较高（13.8% vs. 1.5%[调整风险差异 13.0%[7.1-18.9]，p<0.0001]）。未发现其他产妇次要结局差异。
剖宫产组早发性新生儿败血症发生率最高，尤其是胎儿监护异常的产妇。受败血症影响或易患败血症的胎儿可能更需要剖宫产。
