A number of competing risks and benefits influence the rates of neonatal morbidity and mortality in elective cesarean delivery versus expectant management. To compare these rates, we developed complex decision trees to model the expected outcomes among hypothetical cohorts of 1,000,000 uncomplicated pregnancies undergoing elective cesarean delivery versus 1,000,000 comparable pregnancies undergoing routine pregnancy management. A separate tree was created for each complication, including neonatal death, respiratory morbidity, intracranial hemorrhage, and brachial plexus injury. We found that neonatal mortality was increased among elective cesarean deliveries, but perinatal mortality was higher with routine expectant management due to fetal deaths. Respiratory morbidity was substantially more common among infants delivered by elective cesarean delivery, whereas intracranial hemorrhage and brachial plexus injury were less common. We conclude that the fetal/neonatal impact of elective cesarean is mixed, but any improvement in perinatal health is likely to be small.

译文

在选择性剖宫产与预期管理中,许多竞争性风险和收益会影响新生儿的发病率和死亡率。为了比较这些比率,我们开发了复杂的决策树来模拟假设队列中的预期结果,这些队列中的1,000,000例非复杂妊娠接受择期剖宫产,而1,000,000例可比妊娠接受常规妊娠管理。为每种并发症 (包括新生儿死亡,呼吸系统疾病,颅内出血和臂丛神经损伤) 创建了单独的树。我们发现,选择性剖宫产分娩的新生儿死亡率增加,但由于胎儿死亡,常规预期治疗的围产期死亡率更高。在择期剖宫产分娩的婴儿中,呼吸系统的发病率明显更高,而颅内出血和臂丛神经损伤则较少见。我们得出的结论是,选择性剖宫产对胎儿/新生儿的影响是混合的,但是围产期健康的任何改善都可能很小。

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