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Eru tengsl á milli tíðni keisaraskurða og burðarmálsdauða á Íslandi undanfarin 15 ár?

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Authors
Guðný Jónsdóttir
Ragnheiður I. Bjarnadóttir
Reynir Tómas Geirsson
Alexander Smárason
Issue Date
2006-03-01

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No correlation between rates of caesarean section and perinatal mortality in Iceland
Citation
Læknablaðið 2006, 92(3):191-5
Abstract
INTRODUCTION: Caesarean section rates have increased over the past decades without a concomitant decrease in perinatal mortality. In Iceland the same trend has been seen while at the same time perinatal mortality rate has remained low. Most caesarean sections are done at term. Crude perinatal mortality rates give limited information about whether the increase in section rates leads to a lower perinatal death rate among term non-malformed singleton infants. The relation between caesarean section and perinatal mortality rates in singleton, non-malformed infants of birthweight > or =2500 g in Iceland during 1989-2003 was studied. MATERIALS AND METHODS: Information about gestational length, birthweight, parity, onset of labour and previous caesarean section was collected on all singleton births > or =2500 g from the Icelandic Birth Registration and from maternity case records. The same data were obtained for all perinatal deaths > or =2500 g excluding malformed infants irrespective of mode of delivery. The caesarean section and perinatal mortality rates were calculated and the relation between these evaluated by Pearson s correlation coefficient. RESULTS: The total number of deliveries in the study period was 64514 and the mean perinatal mortality rate 6.4/1000 (range: 3.6-9.2/1000). A significant increase was found in the overall caesarean section rate, from 11.6% to 18.2% (p<0.001). There were 61633 singleton infants > or =2500 g and 8332 were born by caesarean section. There were 111 perinatal deaths among this cohort giving a mean perinatal mortality rate (PNMR) of 1.8/1000 (range 0.8-4.1/1000). While for singleton non-malformed infants the caesarean section rate increased from 10.4% to 16.7% (p<0.001), the PMNR did not decrease significantly. For primiparous women the caesarean section rate increased from 12% to 18% with no correlation with the PNMR (0.6/1000). CONCLUSION: Despite a 60% rise in the caesarean section rate during the study period, no reduction of the perinatal mortality rate among infants > or =2500 g was found in this population with a prior low perinatal mortality, neither among primi- nor multiparous women.
Ágrip Inngangur: Tíðni fæðinga með keisaraskurði hefur víða margfaldast undanfarna áratugi án þess að burðarmálsdauði (BMD) hafi lækkað á sama tíma. Á Íslandi hefur keisaraskurðum fjölgað verulega og burðarmálsdauði haldist lágur. Óvíst er um tengsl þar á milli. Flestir keisaraskurðir eru gerðir hjá konum við fulla meðgöngu. Börn sem deyja á burðarmálstíma eru einkum fyrirburar og heildartölur um BMD gefa takmarkaða mynd af því hvort fjölgun keisaraskurða skili sér í færri dauðsföllum barna sem hafa náð eðlilegri fæðingarþyngd. Tilgangur rannsóknarinnar var að meta hugsanleg tengsl keisaraskurða við burðarmálsdauða hjá einburum sem vógu ≥2500 g við fæðingu. Efniviður og aðferðir: Upplýsingar um meðgöngu­lengd, þyngd barns, fjölda barna, upphaf fæðingar og fyrri keisaraskurði kvenna sem fóru í keis­ara­skurð á rannsóknartímanum (1989-2003) voru fengn­ar úr Fæðingaskráningunni og sjúkraskrám. Af þeim voru allar konur með einbura ≥2500 g valdar í rannsóknarhópinn. Sömu upplýsingar voru fengnar um einbura 2≥2500 g án alvarlegra van­skapnaða sem dóu á burðarmálstíma, óháð fæð­ingarmáta. Breytingar á tíðni keisaraskurða og BMD voru metnar með Pearsons fylgnistuðli. Niðurstöður: Alls fæddu 64514 konur 65619 börn árin 1989-2003. Þar af dóu 419 börn á burð­ar­málstíma. BMD breyttist ekki marktækt á rannsóknartíma og var að meðaltali 6,4/1000 (bil: 3,6-9,2/1000). Heildartíðni keisaraskurða hækk­aði marktækt úr 11,6% í 18,2% (p<0,001). Alls fæddu 61633 konur einbura ≥2500 g, þar af 8332 með keisaraskurði. Af þeim börnum sem dóu burðarmálsdauða voru 111 >2500 g. Tíðni keis­ara­skurða í rannsóknarhópnum jókst úr 10,4% í 16,7% (p<0,001). Ekki var marktæk fylgni við BMD í þessum hópi, en meðaltalstíðni BMD var 1,8/1000 (bil: 0,8-4,1/1000). Meðal frumbyrja jókst keisaratíðnin úr 12% í 18%, einnig án fylgni við BMD (meðaltal 0,6/1000). Ályktanir: Fjölgun keisaraskurða við fæðingu einbura með fæðingarþyngd ≥2500 g hefur ekki leitt til marktækrar fækkunar dauðsfalla hjá þess­um hópi barna á síðastliðnum 15 árum.
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