剖宫产对学龄期儿童注意力影响的研究

目的:探讨不同原因剖宫产对学龄期儿童注意力的影响。方法:将308例健康学龄期儿童分为自然分娩组（n＝105）、社会因素剖宫产组（n＝101）和医学指征剖宫产组（n＝102）。采用视听整合持续操作测试（IVA-CPT）进行注意力测试。结果:①三组间综合控制、听觉反应控制、综合注意、听觉注意力、视觉注意力、听觉警醒、视觉一致性、视觉警醒、视觉注意集中等9项商数差异有显著性（P＜0.05）;②医学指征剖宫产组IVA-CPT结果明显差于自然分娩组和社会因素剖宫产组,而社会因素剖宫产组与自然分娩组差异无显著性意义。结论:剖宫产手术本身对健康学龄期儿童的注意力无明显影响,影响剖宫产儿童注意力的真正原因是导致剖宫产的医学指征。［中国当代儿科杂志,2009,11（11）：913-916］     

剖宫产对学龄期儿童注意力影响的研究

目的探讨不同原因剖宫产对学龄期儿童注意力的影响。方法将308例健康学龄期儿童分为自然分娩组(n=105)、社会因素剖宫产组(n=101)和医学指征剖宫产组(n=102)。采用视听整合持续操作测试(IVA-CPT)进行注意力测试。结果①三组间综合控制、听觉反应控制、综合注意、听觉注意力、视觉注意力、听觉警醒、视觉一致性、视觉警醒、视觉注意集中等9项商数差异有显著性(P<0.05);②医学指征剖宫产组IVA-CPT结果明显差于自然分娩组和社会因素剖宫产组,而社会因素剖宫产组与自然分娩组差异无显著性意义。结论剖宫产手术本身对健康学龄期儿童的注意力无明显影响,影响剖宫产儿童注意力的真正原因是导致剖宫产的医学指征。     

An old problem revisited-hyaline membrane disease and cesarean section

The incidence of hyaline membrane disease (HMD) was investigated retrospectively in 159 preterm infants below 35 weeks gestation, weighing less than 2,000 g, and born during the 5-year interval 1975–79. The incidence of HMD was compared between infants delivered by elective Cesarean section, Cesarean section after the onset of labor and by the vaginal route. A significant difference (P<0.001) was found in the frequency of HMD dependant on the mode of delivery; 50% of infants delivered by elective Cesarean section developed HMD versus 19.2% in the vaginally delivered group. In infants delivered vaginally premature rupture of membranes (PROM) lowered the incidence of HMD to 5% compared to 32.4% in infants without PROM (P<0.01). When infants (<2,000 g) delivered vaginally without PROM were compared with those delivered by elective Cesarean section, no difference in HMD-incidence was observed. Out of 43 infants with birthweight above 2,000 g, who developed HMD during the 5-year period the majority had been delivered by elective Cesarean section. The possible effect of fetal stress on lung maturation is discussed.     

剖宫产与新生儿高胆红素血症病例对照研究

目的探讨剖宫产分娩与新生儿高胆红素血症(简称,高胆)的关系。方法对我院2003年1月至2004年12月期间在产科出生的新生儿进行病例对照研究,通过监测经皮胆红素、血清胆红素,比较剖宫产与非剖宫产娩出新生儿发生高胆的情况。结果多因素分析结果显示影响新生儿高胆红素血症的因素包括:剖宫产、母乳缺乏、生后头3天体重下降明显、高龄初产、胎龄、宫内窘迫等,剖宫产组新生儿高胆发生率为36.9%,非剖宫产组新生儿高胆发生率为21.8%,两者差异有显著性(P<0.01)。剖宫产组中母亲有妊高征者新生儿高胆发生率略高于母亲无妊高征者,两者间差异无显著性(P>0.05);两组患儿合并窒息、缺氧缺血性脑病(HIE)、吸入综合征、感染等疾病对高胆的影响差异无显著性(P>0.05)。结论剖宫产可能是引起新生儿高胆的原因之一。     

剖宫产与新生儿高胆红素血症病例对照研究

目的探讨剖宫产分娩与新生儿高胆红素血症（简称，高胆）的关系。方法对我院2003年1月至2004年12月期间在产科出生的新生儿进行病例对照研究，通过监测经皮胆红素、血清胆红素，比较剖宫产与非剖宫产娩出新生儿发生高胆的情况。结果多因素分析结果显示影响新生儿高胆红素血症的因素包括：剖宫产、母乳缺乏、生后头3天体重下降明显、高龄初产、胎龄、宫内窘迫等，剖宫产组新生儿高胆发生率为36．9％，非剖宫产组新生儿高胆发生率为21．8％，两者差异有显著性（P〈0．01）。剖宫产组中母亲有妊高征者新生儿高胆发生率略高于母亲无妊高征者，两者间差异无显著性（P〉0．05）；两组患儿合并窒息、缺氧缺血性脑病（HIE）、吸入综合征、感染等疾病对高胆的影响差异无显著性（P〉0．05）。结论剖宫产可能是引起新生儿高胆的原因之一。     

缩宫素在妊娠晚期及剖宫产术后大鼠体内的药代动力学研究

目的 探讨缩宫素在妊娠晚期及剖宫产术后大鼠体内药代动力学变化的特点,为缩宫素的临床应用提供参考.方法 SPF级SD大鼠36只随机分成6组,每组6只.A、B、C组为妊娠晚期组,分别单次尾静脉注射0.1、0.5、5 U/kg的缩宫素;D、E、F组为剖宫产术后组,行剖宫产术后分别单次尾静脉注射0.1、0.5、5 U/kg的缩...     

The rising incidence and impact of non-medically indicated pre-labour cesarean section in Latin America

In the poorest populations of the world the difficulties of performing a surgical procedure lead to extremely low cesarean section rates associated with very high perinatal mortality. Meanwhile the proportion of births by cesarean section has been increasing for several decades in many areas of the world, reaching alarmingly high rates especially in Latin America. This review aims to describe this secular trend. The causes of the increase in cesarean deliveries are analyzed with a multidimensional approach, trying to recognize the reasons behind the choice of the route of delivery. We are facing a shift in the guiding paradigm, leaving the classical biomedical one. Advantages and disadvantages of non-medically indicated cesarean section are being sought, comparing it with the results of vaginal delivery, with special emphasis on the short- and long-term morbidity of the newborn. Several variables involved in this controversial topic are considered, with the objective of stimulating critical thoughts about the medical, bioethical and social aspects of the increasing trend in the cesarean section rate.     

剖宫产与学龄前儿童感觉统合失调的前瞻性队列研究

目的 采用前瞻性队列研究,评价剖宫产与学龄前儿童感觉统合失调的关联。 方法 依托上海交通大学医学院附属新华医院和附属国际和平妇幼保健院2012年建立的多中心母婴队列,于2017年采用儿童感觉统合能力发展评定量表,从前庭平衡、触觉防御和本体觉3个维度评价392名学龄前儿童感觉统合功能。剖宫产出生为暴露因素,阴道分娩者作为对照组。采用多因素logistic回归分析评估剖宫产与感觉统合各维度失调的关联。 结果 学龄前儿童感觉统合失调率为21.9%（86/392）,前庭平衡、触觉防御和本体觉失调率分别为5.9%（23/392）、5.4%（21/392）和15.1%（59/392）。调整母亲分娩年龄、母亲受教育程度及儿童出生情况等混杂因素后,剖宫产儿童发生本体觉失调的风险性显著增加（RR=4.16,95%CI：1.41~12.30,P<0.05）。按性别分层分析发现,剖宫产男童本体觉失调的发生风险高于阴道分娩男童（RR=5.75,95%CI：1.26~26.40,P<0.05）。 结论 剖宫产能显著增加学龄前儿童本体觉失调的发生风险,尤其是对男童的影响更为明显。     

宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血的效果

目的比较局部缝合术与宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血的临床效果及预后影响。方法选取秦皇岛市海港医院2012年10月至2017年10月收治的前置胎盘剖宫产术发生宫颈管出血的患者64例,依据宫颈缝合方式分为宫颈上提缝合组和局部缝合组,每组32例。比较两组患者的手术情况(包括手术时间、术中出血量、红细胞悬液输入量、血浆输入量、止血时间、术后1 d阴道流血量)、宫颈管出血原因及程度。术后随访8周,比较两组患者腹腔感染率、子宫切除率及产褥病率。结果宫颈上提缝合组患者手术时间[(74±15)min]、止血时间[(18±4)min]均明显短于局部缝合组[分别为(97±20)min、(33±7)min, P值均<0.05]。宫颈上提缝合组患者术中出血量[(769±88)ml]、红细胞悬液输入量[(429±28)ml]、血浆输入量[(112±21)ml]、术后1 d阴道流血量[(99±18)ml]均明显少于局部缝合组[分别为(925±104)、(538±44)、(190±44)、(169±23)ml,P值均<0.05]。宫颈上提缝合组与局部缝合组患者宫颈管出血原因及程度比较差异无统计学意义(P>0.05);术后8周宫颈上提缝合组腹腔感染率(3.12%)、子宫切除率(0.00%)均明显低于局部缝合组(分别为9.37%、12.50%,P值均<0.05),两组患者产褥病率比较差异无统计学意义(P>0.05),宫颈上提缝合组术后总不良反应发生率(9.37%)明显低于局部缝合组(31.25%,P<0.05)。结论宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血对于患者术中情况有明显改善,安全性高,预后好,值得在临床推广。     

The impact of cesarean section on neonatal outcome of infants born at 23 weeks of gestation

Objective

Determine the impact of cesarean section (CS) on neonatal outcome of infants born at 23 weeks of gestation.

Methods

A retrospective study was performed involving 34 infants born at 23 weeks and 91 infants born at 24–26 weeks. Indications necessitating delivery were severe pregnancy induced hypertension, non-reassuring fetal heart rate patterns (NRFHRs), or intrauterine infection (IUI). Obstetrical indication for CS included NRFHR and breech presentation. Poor outcome included neonatal death or cerebral palsy. Univariate and multiple logistic analyses were performed to determine the effect of CS for obstetrical indications on poor outcome.

Results

The incidence of poor outcome was significantly higher at 23 weeks (number of poor outcomes/total number: 22/34) compared to that (31/91) at 24–26 weeks (p < 0.01). The incidence of a poor outcome was significantly higher at 23 weeks for infants having NRFHR (11/16) compared to those at 24–26 weeks (15/43, p = 0.02). However, the incidence of a poor outcome was similar in infants with IUI (6/10 at 23 weeks versus 5/11 at 24–26 weeks, p = 0.41). Vaginal birth in cases of obstetrical indication for CS at 23 weeks was associated with higher risk of a poor outcome (odds ratio: 8.2). In contrast, the risk at 24–26 weeks was not higher (OR, 0.8). After adjustment using variables of vaginal birth and IUI, vaginal birth significantly affected poor outcome (OR, 13.0).

Conclusion

Poor neonatal outcome was closely related to the mode of delivery, suggesting that CS for obstetrical indication at 23 weeks may improve neonatal outcome.     

The neonatal respiratory outcome in relation to timing of elective cesarean section at 38 versus 39 week gestation: A single center based study

BackgroundCesarean delivery per se is a risk factor of respiratory morbidity in term neonates and its timing is an adding factor of increased rates of respiratory complications.ObjectiveWe aimed to identify the association between elective cesarean delivery at 38 versus 39 week gestation and neonatal respiratory morbidity.Materials and methodsWe selected 200 pregnant women who underwent elective cesarean delivery at 38 or 39 week gestation at the Kasr El-Aini hospital. Mothers were subjected to ultrasound examination. Neonates with respiratory distress were subjected to laboratory investigations and chest X-ray.ResultsWe found no association between the development of any type of respiratory distress and maternal age or parity. The prevalence of respiratory morbidity was 25% in group A compared to 11% in group B (p = 0.01) and risk estimation showed that delivery at 38 weeks carries 2.7 time risk of having a newborn suffering from respiratory morbidity (95% CI: 1.2–5.8). TTN was observed in 11% of group A compared to 7% of newborns of group B (p = 0.6). RDS developed in 3 cases of group A, while none of group B developed RDS (p = 0.1). The rate of NICU admission, mechanical ventilation in the 1st 24 h and long hospital stay were insignificantly higher in group A (p>0.05). There were no neonatal deaths in both groups.ConclusionElective cesarean delivery at 39 week gestation is associated with a better neonatal respiratory outcome. Further studies are recommended to identify the best time of elective cesarean delivery associated with the least neonatal and maternal morbidity.     

Interleukin-10 and transforming growth factor-β1 in cord blood: relationship with paternal allergy and cesarean section

Aim: To measure Interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1) in cord blood and assess their relationship with parental allergy and perinatal characteristics.
Methods: In a neonatal care unit 212 consecutive full-term and appropriate for gestational age newborns were recruited. IL-10 and TGF-β1 levels were determined in cord blood by high sensitivity ELISA. Perinatal characteristics, mode of delivery and presence of allergy in parents were recorded.
Results: Out of 212 newborns, 136 were of non-allergic parents and 76 (35.8%) of one or both allergic parents. In newborns of allergic fathers median IL-10 levels tended to be lower (0.67 vs. 1.06 pg/mL, p = 0.07) and TGF-β1 levels were significantly lower (40.9 vs. 45.3 ng/mL, p = 0.008) than in newborns of non-allergic parents. Multiple general regression analysis showed that presence of paternal allergy (β=−0.19, p = 0.003) to be born by cesarean section (β=−0.21, p = 0.03) and younger gestational age (β= 0.14, p = 0.04) independently contributed to decrease TGF-β1 levels (multiple R = 0.38, p < 0.0001).
Conclusion: Paternal allergy and cesarean section are associated to decreased TGF-β1, which might be the mediator of the increased risk of atopy development. Cord blood IL-10 and TGF-β1 levels of our newborn series could be used as reference values for further studies on these relationships.     

选择性剖宫产对新生儿近远期的影响

剖宫产手术技术的日臻完善、临床上对剖宫产手术指征的放宽以及对剖宫产术对新生儿不利影响的认识不足,都在一定程度上促使了剖宫产率的大幅上升.该文围绕选择性剖宫产手术对新生儿近期及远期的影响,分析其与新生儿呼吸系统疾病、医源性早产、免疫系统建立以及特异反应性疾病等之间的联系.目前认为,剖宫产手术虽不能作为独立危险因素存在,但可与其他因素产生协同作用,增加新生儿的病死率.所以,临床上应严格掌握手术指征,降低无手术指征的选择性剖宫产率.     

Neurological adaptation of infants delivered by emergency or elective cesarean section

The effects of intrapartal asphyxia on neonatal neurological condition have been studied in 17 full-term infants delivered by emergency cesarean section and in 30 full-term infants delivered by elective cesarean section used as controls. A neurological examination consisting of 31 items was performed on days 1, 2 and 5 after birth. A tonus score, an excitability score as well as the number of optimal responses were calculated. A follow-up examination was done at six months of age with a standardized neurological and developmental examination. The results showed that infants born after emergency cesarean section were significantly more hypotone the first two days after delivery than the infants in the elective cesarean section group. In regard to individual neurological items, significant differences were found between the emergency and elective cesarean section in reaction to sound, rooting, patellar, Moro and stepping reflexes with weaker reactions in the elective cesarean section group. Growth, psychomotor development and neurological status at six months did not differ significantly between the groups. Our findings indicate that full-term infants born after emergency cesarean section due to mild intrapartal asphyxia have a delayed neurological adaptation as expressed by poor muscular tonus during their first days of life compared with infants born after elective cesarean section.     

选择性剖宫产与新生儿呼吸系统疾病相关性分析

目的 评估不同胎龄足月儿选择性剖宫产（ECD）分娩后呼吸系统疾病的发生风险,探讨减少新生儿呼吸系统疾病发生的ECD时机.方法 对2008年6月至2013年6月在郑州人民医院行ECD分娩的新生儿进行回顾性分析.入选标准：胎龄37 ～ 39周,单胎,母亲无妊娠期合并症和并发症,剖宫产前无胎膜早破及临产征象.分析胎龄37、38、39周三组新生儿的一般情况及呼吸系统疾病发生情况.结果 共有1152例胎龄37～39周的ECD新生儿纳入研究,37周组136例,38周组401例,39周组615例,因发生呼吸系统疾病转入新生儿科的病例94例,其中37周组20例,呼吸系统疾病发生率14.7％;38周组38例,呼吸系统疾病发生率9.5％;39周组36例,呼吸系统疾病发生率5.8％.胎龄越大,ECD新生儿呼吸系统疾病发生率越低,差异有统计学意义（P＜0.05）.胎龄37 ～ 39周ECD新生儿中,发生的呼吸系统疾病以湿肺、窒息及肺炎为主,湿肺共51例,占54.2％;窒息共9例,占9.6％;肺炎共17例,占18.1％.胎龄37周和38周进行ECD的新生儿呼吸系统疾病发生率均较胎龄39周增高（OR分别为2.5和1.8,P均＜0.05）.结论 胎龄37 ～ 38周进行ECD可增加新生儿呼吸系统疾病的发生率,ECD尽可能在妊娠39周后进行.     

Comparative analysis of neonatal morbidity for vaginal and caesarean section deliveries using hospital charge

Aim: To assess the neonatal morbidity of alternative modes of delivery using economic data. Methods: Two groups of neonatal morbidity data were extracted according to mode of delivery from inpatient claims on National Health Insurance in Taiwan: uncomplicated vaginal and caesarean section deliveries. Outcome variables included number of infants treated as inpatients, duration of hospital stay, and hospital charge during both the first month and the first year of age. Results: Uncomplicated caesarean section delivery of term infants carried a significant increase either in the first month of life or during the first year after birth in both duration of hospital stay and hospital discharge when compared with uncomplicated vaginal delivery. Neonatal jaundice accounted for the greatest morbidity among term newborns, irrespective of delivery mode, followed by infectious, gastrointestinal and respiratory morbidity. Logistic regression analysis demonstrated that uncomplicated vaginal delivery was associated with skin diseases. Uncomplicated caesarean section delivery was associated with infectious disease and disease of the respiratory, digestive and circulatory systems. Conclusion: The findings of this study may provide further information for clinicians and would be an important consideration when advising pregnant women on the preferred route of delivery.     

Effect of cesarean section on relapse of childhood idiopathic nephrotic syndrome

In parallel with the increase in the prevalence of childhood chronic diseases, the rate of cesarean delivery has risen during the past decades. This study tested the hypothesis that children delivered by cesarean section (CS) have a higher risk of relapse of idiopathic nephrotic syndrome (INS). Fifty‐six children with INS were categorized into three groups. Group A consisted of patients with INS who had no relapses after the onset of INS; group B consisted of patients with INS who had infrequent relapse; and group C consisted of patients with INS who had frequent relapse. The number of enrolled patients in groups A, B, and C was 10, 14, and 32, respectively. The ratio of neonates delivered via CS was significantly higher in group C (37.5%, P < 0.001) than in groups A (0%) and B (7.1%). This study shows that CS is associated with an increased risk of relapse of childhood INS.     

Birth by cesarean section is associated with elevated neonatal plasma levels of dimethylarginines

Background: This study was undertaken to compare the effects of vaginal delivery and cesarean section on the l‐arginine‐nitric oxide system by measuring levels of l‐arginine, an endogenous nitric oxide synthase antagonist asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) in the cord blood and postnatally. Methods: Plasma samples were obtained from the umbilical vein and artery at birth and from peripheral venous blood on the second postnatal day in 30 full‐term newborn infants: 10 born vaginally and 20 born by cesarean section. Results: After vaginal delivery, ADMA concentration was higher in the umbilical vein than in the umbilical artery (mean 1.06 vs 0.90 µmol/L [P= 0.027]); and ADMA level fell after birth to 0.66 µmol/L on the second postnatal day (P= 0.007 vs umbilical artery). Newborns born by cesarean section had similar ADMA levels in umbilical arterial and venous blood, 1.19 and 1.18 µmol/L, and the ADMA level fell to 0.84 µmol/L by the second postnatal day (P < 0.001). Vaginal birth induced neither significant umbilical venoarterial difference nor a postnatal fall in SDMA. After cesarean section, SDMA was essentially the same in umbilical vein, umbilical artery and postnatal peripheral vein samples. At 2 days of age, both ADMA and SDMA levels stayed higher in infants born by cesarean section than in vaginally born infants. Conclusions: ADMA level falls after both vaginal and cesarean birth, whereas SDMA level does not. The higher ADMA level after cesarean birth compared with vaginal birth may contribute to decreased nitric oxide production and bioavailability in neonatal vascular beds.