Damtew Beyene Sisay, Hailu Alemu Merga, Fente Bezawit Melak, Workneh Tadesu Wondu, Abdi Hinsermu Bayu
College of Health Science, Department of Midwifery, Arsi University, Asella, Ethiopia.
Department of Midwifery, Wollega University College of Health Science, Nekemte, Ethiopia.
BMC Pregnancy Childbirth. 2024 Dec 30;24(1):881. doi: 10.1186/s12884-024-07037-2.
The World Health Organization recommends a cesarean delivery rate of 5-15%, which is thought to be within the range that can reduce infant morbidity and mortality. Various investigations have shown that those poor newborn outcomes are influenced by a variety of maternal and fetal factors and are more prevalent in emergencies than planned cesarean deliveries. Ethiopia is one of the five nations that account for 50% of all neonatal fatalities worldwide. Sub-Saharan African countries account for 38% of all infant deaths worldwide.
To know the determinants of adverse early neonatal outcomes after emergency cesarean delivery.
A multicenter case-control study design would be carried out between November 2022 and January 2023. Using the consecutive method, a sample of 318 mother-newborn pairs was studied. Direct observation and face-to-face interviews were undertaken to gather the data using a semi-structured questionnaire. For both data input and analysis, Epi Data version 4.6 and Stata version 14 software were used. Both the crude and adjusted odds ratios were computed. The measure of significance was based on the adjusted odds ratio with a 95% confidence interval and a p-value of less than 0.05.
Maternal age over 35, the presence of danger signs during pregnancy, and non-reassuring fetal heart rate were significantly associated with increased risk of adverse fetal outcomes following emergency cesarean section. Women aged over 35 were 3.6 times more likely to experience adverse fetal outcomes compared to younger women (AOR: 3.6, 95% CI: 1.1, 9.7). Women with danger signs during pregnancy were 3.5 times more likely to have adverse fetal outcomes compared to those without (AOR = 3.5, 95% CI: 2.4, 36). Similarly, cases with non-reassuring fetal heart rate were associated with a 5.2 times higher risk of adverse newborn outcomes (AOR = 5.2, 95% CI: 1.1, 26).
This study identified advanced maternal age (over 35 years old), pregnancy complications, and non-reassuring fetal heart rate as significant risk factors for adverse neonatal outcomes following emergency cesarean section.
世界卫生组织建议剖宫产率为5%-15%，认为该范围可降低婴儿发病率和死亡率。多项调查显示，不良新生儿结局受多种母体和胎儿因素影响，在急诊剖宫产中比计划剖宫产更为普遍。埃塞俄比亚是全球50%新生儿死亡病例的五个国家之一。撒哈拉以南非洲国家占全球所有婴儿死亡病例的38%。
了解急诊剖宫产后早期新生儿不良结局的决定因素。
2022年11月至2023年1月将开展一项多中心病例对照研究。采用连续抽样法，研究了318对母婴样本。使用半结构化问卷通过直接观察和面对面访谈收集数据。数据录入和分析均使用Epi Data 4.6版和Stata 14版软件。计算了粗比值比和调整后的比值比。显著性检验基于调整后的比值比，其95%置信区间和p值小于0.05。
产妇年龄超过35岁、孕期出现危险信号以及胎儿心率异常与急诊剖宫产后不良胎儿结局风险增加显著相关。35岁以上的女性发生不良胎儿结局的可能性是年轻女性的3.6倍（调整后的比值比：3.6，95%置信区间：1.1，9.7）。孕期有危险信号的女性发生不良胎儿结局的可能性是没有危险信号的女性的3.5倍（调整后的比值比 = 3.5，95%置信区间：2.4，3.6）。同样，胎儿心率异常的病例发生不良新生儿结局的风险高5.2倍（调整后的比值比 = 5.2，95%置信区间：1.1，26）。
本研究确定高龄产妇（35岁以上）、妊娠并发症和胎儿心率异常是急诊剖宫产后不良新生儿结局的重要危险因素。
