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

:许多竞争性风险和收益影响选择性剖宫产与预期管理方式下新生儿发病率和死亡率的比率。为了比较这些比率,我们开发了复杂的决策树以对假设的队列中的预期结果进行建模,这些假设队列中有1,000,000例进行了选择性剖宫产的未合并妊娠与1,000,000例进行了常规妊娠管理的可比较的妊娠。为每种并发症创建一棵单独的树,包括新生儿死亡,呼吸系统疾病,颅内出血和臂丛神经损伤。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,常规的常规处理导致围产期死亡率更高。择期剖宫产分娩的婴儿中呼吸系统疾病的发病率更为普遍,而颅内出血和臂丛神经损伤的情况则较不常见。我们得出结论,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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