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目的:目前剖宫产后未经试产的重复剖宫产率不断上升。本研究拟探讨美国产妇试产率的下降与新生儿出生结局之间的关系。方法:采用1995至2002年间美国出生登记资料进行分析。选取既往剖宫产术分娩过一次单胎的产妇作为研究对象。通过多元logistic回归估算试产率高和低的两个时段中,新生儿不良出生结局与试产之间的调整OR值。结果:本研究共选取了1833407名研究对象。美国既往剖宫产产妇再次分娩时的试产率从1995年的38.5%降低至2002年的15.0%。在此期间产妇的基线资料没有发生具有统计学意义的改变。既往剖宫产产妇再次分娩时未经试产会增加新生儿发生窒息死亡和患病的风险。通过分析试产率最低的2002年的数据,发现该风险在低危产妇中仍然存在。结论:美国产妇剖宫产后再次分娩时试产率下降导致了新生儿不良结局的发生率上升。
Objective: At present, the rate of repeat cesarean section without trial after cesarean section is continuously rising. This study was to explore the relationship between the drop in test-yield in the United States and the neonatal outcome. METHODS: Data from the United States of America registration data from 1995 to 2002 were analyzed. Select the past cesarean delivery once a single child of mothers as the research object. Multivariate logistic regression was used to estimate the adjusted odds ratio (OR) between the neonatal unborn birth outcome and trial production in two periods of high and low trial yields. Results: A total of 1833407 subjects were selected for this study. The trial yield of the former cessation maternity childbirth in the United States decreased from 38.5% in 1995 to 15.0% in 2002. There was no statistically significant change in the baseline data for the mothers during this period. Previous cesarean delivery of childbirth without retesting increases the risk of neonatal death and illness from asphyxiation. By analyzing the 2002 trial with the lowest yield, the risk was found to persist in low-risk mothers. CONCLUSIONS: The decline in trial yields of cesarean sections after delivery in the United States led to an increase in the incidence of adverse neonatal outcomes.