Petitti D B, Cefalo R C, Shapiro S, Whalley P
Obstet Gynecol. 1982 Jan;59(1):6-12.
To study time trends in maternal mortality in the United States and to attempt to compare the risk of cesarean with vaginal delivery, information from the Professional Activities Study of the Commission on Professional and Hospital Activities for 3 years-1970, 1974, and 1978-was reviewed. For all deliveries, mortality per 100,000 deliveries declined from 25.7 in 1970 to 14.3 in 1978. For vaginal deliveries, mortality per 100,000 deliveries declined from 20.4 to 9.8. For cesarean deliveries, mortality per 100,000 births decreased more than for vaginal deliveries, from 113.8 to 40.9. Mortality for deliveries with no mention of complications, lacerations, or uterine rupture declined significantly from 1970 to 1978. Mortality for deliveries complicated by dystocia or malpresentation declined significantly from 1970 to 1974, but failed to decline thereafter. Mortality for deliveries complicated by a previous cesarean or by antepartum hemorrhage did not decline significantly from 1970 to 1978. For all complications with a sufficient number of vaginal and cesarean deliveries, except deliveries complicated by malpresentation or antepartum hemorrhage, mortality was at least twice as high in cesarean as in vaginal deliveries. Based on a comparison of mortality after a previous cesarean with mortality for all vaginal deliveries with no complication, the authors conclude that cesarean delivery is probably neither less than 2 nor more than 4 times more hazardous than vaginal delivery.
为研究美国孕产妇死亡率的时间趋势，并尝试比较剖宫产与阴道分娩的风险，我们回顾了专业医院活动委员会专业活动研究在1970年、1974年和1978年这3年的信息。所有分娩中，每10万例分娩的死亡率从1970年的25.7降至1978年的14.3。阴道分娩中，每10万例分娩的死亡率从20.4降至9.8。剖宫产分娩中，每10万例出生的死亡率下降幅度大于阴道分娩，从113.8降至40.9。未提及并发症、裂伤或子宫破裂的分娩死亡率在1970年至1978年期间显著下降。因难产或胎位异常而并发的分娩死亡率在1970年至1974年期间显著下降，但此后未能下降。因既往剖宫产或产前出血而并发的分娩死亡率在1970年至1978年期间没有显著下降。对于所有有足够数量阴道分娩和剖宫产分娩的并发症，除了因胎位异常或产前出血而并发的分娩外，剖宫产的死亡率至少是阴道分娩的两倍。基于既往剖宫产术后死亡率与所有无并发症阴道分娩死亡率的比较，作者得出结论，剖宫产分娩的危险性可能不比阴道分娩高2倍，也不比其高4倍。
