Çarkçı Yıldız Damla, Yapar Eyi Elif Gül
University of Health Sciences, Ministry of Health Ankara Bilkent City Hospital, Çankaya Ankara Türkiye.
AJOG Glob Rep. 2025 Feb 21;5(2):100464. doi: 10.1016/j.xagr.2025.100464. eCollection 2025 May.
Türkiye is the largest host country for refugees and asylum seekers and provides comprehensive maternal care, including antenatal, intrapartum, and postpartum services. However, there is a notable gap in comparative data regarding neonatal and postneonatal mortality for cesarean sections among Turkish citizens and refugees/asylum seekers.
The study aims to: (1) Compare neonatal and postneonatal mortality rates across Robson groups among Turkish citizens and refugees/asylum seekers. (2) Identify risk factors related to neonatal and postneonatal deaths, considering Robson Classification, clinical obstetric parameters, and demographics. (3) Investigate the primary causes of neonatal/postneonatal deaths in a hospital with a cesarean section rate of 48.43%.
A retrospective cross-sectional study based on hospital electronic data was conducted, analyzing 25,631 cesarean section births. The participants included 89% Turkish citizens and 11% refugees/asylum seekers. Student's t-test, χ² -test, Mann-Whitney U test, Kruskal-Wallis analysis, and logistic regression were applied to identify risk factors and make comparisons.
Neonatal Deaths: Out of 26,474 live births, 513 newborns died. Mortality rates were 21.94 per 1000 live births for refugees/asylum seekers and 19.05 per 1000 live births for Turkish citizens. Robson Group Distribution: The distribution of cesarean births across Robson groups was varied, with the highest mortality rates observed in groups R8, R9, R10, R6, and R7 (=.001). Risk Factors: Logistic regression analysis identified Robson groups, fetal presentation, gestational age, Apgar scores, and newborn weight/height as significant risk factors for neonatal /postneonatal mortality. However, no significant associations were found with demographic factors, including maternal age, parity, and nationality. Main Causes of Deaths: The leading causes were prematurity (452 cases), congenital abnormalities (160 cases), infections (78 cases), asphyxia (17 cases), and meconium aspiration syndrome (9 cases).
The integration of the Robson Classification with neonatal and postneonatal mortality data offers a structured method to assess cesarean section outcomes, emphasizing the significant variation in mortality rates across different Robson groups. Notably, the highest risks were linked to multiple pregnancies, abnormal fetal presentations, and preterm births.
土耳其是接收难民和寻求庇护者最多的国家，并提供全面的孕产妇护理，包括产前、产时和产后服务。然而，在土耳其公民与难民/寻求庇护者剖宫产的新生儿及新生儿后期死亡率的比较数据方面存在显著差距。
本研究旨在：（1）比较土耳其公民与难民/寻求庇护者各罗布森组的新生儿及新生儿后期死亡率。（2）考虑罗布森分类、临床产科参数和人口统计学因素，确定与新生儿及新生儿后期死亡相关的危险因素。（3）在剖宫产率为48.43%的一家医院中调查新生儿/新生儿后期死亡的主要原因。
基于医院电子数据进行了一项回顾性横断面研究，分析了25631例剖宫产分娩。参与者包括89%的土耳其公民和11%的难民/寻求庇护者。应用学生t检验、χ²检验、曼-惠特尼U检验、克鲁斯卡尔-沃利斯分析和逻辑回归来确定危险因素并进行比较。
新生儿死亡：在26474例活产中，有513例新生儿死亡。难民/寻求庇护者的死亡率为每1000例活产21.94例，土耳其公民为每1000例活产19.05例。罗布森组分布：剖宫产在各罗布森组中的分布各不相同，在R8、R9、R10、R6和R7组中观察到最高死亡率（P =.001）。危险因素：逻辑回归分析确定罗布森组、胎位、孕周、阿氏评分和新生儿体重/身高是新生儿/新生儿后期死亡的重要危险因素。然而，未发现与包括产妇年龄、产次和国籍在内的人口统计学因素有显著关联。主要死亡原因：主要原因是早产（452例）、先天性异常（160例）、感染（78例）、窒息（17例）和胎粪吸入综合征（9例）。
将罗布森分类与新生儿及新生儿后期死亡率数据相结合，提供了一种评估剖宫产结局的结构化方法，强调了不同罗布森组死亡率的显著差异。值得注意的是，最高风险与多胎妊娠、异常胎位和早产有关。
