剖宫产术对母体和胎婴儿的风险及益处  

Maternal and neonatal individual risks and benefits associated with caesarean delivery

作　　者：姚友春[1] 周雷[1] 姚爱香[1] 

机构地区：[1]湖北省荆门市第一人民医院妇产科,448000

出　　处：《重庆医学》2010年第15期2031-2033,共3页Chongqing medicine

摘　　要：目的探讨剖宫产术对母体和胎婴儿的风险及益处。方法对湖北省荆门市第一人民医院产科2008年7月至2009年7月住院分娩的900例产妇的临床资料进行回顾性分析。结果剖宫产妇女发生严重产褥期疾病的风险明显高于阴道分娩者,其术后使用抗生素的风险是阴道分娩者的5倍,但可减少严重软产道裂伤并发症。排除多变量和孕周后,择期剖宫产可减少死胎的发生。头先露择期及产时剖宫产术均可增加新生儿重症监护(≥7d)的风险。排除多变量及孕周后,其优势比及可信区间(CI)分别为2.1(1.75～2.55)、1.93(1.63～2.79),同时可增加新生儿死亡率,其优势比及CI分别为1.66(1.26～2.2)、1.99(1.51～2.63)。臀位先露剖宫产术并不增加这种风险。结论剖宫产术益处为可减少母体严重软产道裂伤并发症及提供臀先露新生儿好的结局,头先露择期剖宫产术可减少死胎的发生,但剖宫产术同时增加了母体和新生儿患病和死亡的风险。Objective To assess the risks and benefits associated with caesarean delivery. Methods The retrospectively analysis was performed on 900 cases of pregnant women who delivery in the first people＇s hospital of Jingmen from July 2008 to July 2009. Results Women undergoing caesarean delivery had an increase risk of severe maternal morbidity compared with women undergoing vaginal delivery. The risk of antibiotic treatment after delivery for women having either type of caesarean was live times that of women having vaginal deliveries, hut caesarean delivery hod a large protective effect on the incidence of third and fourth degree periheal laceration. There was a trend towards a reduced odds ratio for fetal death with elective caesarean,after adjustment for possible confounding variables and gestational age. Wilh cephalic presentation, however, independent of possible confounding variables and gestational age,elective and inlrapartum caesarean increased the risk for a stay of seven or more days in neonatal intensive care[2.1 （1.75-2.55）and 1.93（1.63- 2.79）,respectively],and the risk of neonatal mortality up to hospital discharge[1. 66（1. 26-2. 2） and 1.99（1.51-2.63 ）, respectively], which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Conclusion Caesarean delivery has a large protective effect on the incidence of third and fourth degree perineal laceration,and it independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations, but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.

关 键 词：剖宫产 阴道分娩 风险 益处 

分 类 号：R719.8[医药卫生—妇产科学]