新冠病毒感染对孕产妇分娩方式的影响

Influence of SARS-CoV-2 infection on delivery mode among pregnant women

目的描述新冠疫情期间孕产妇的分娩方式现状,并探索确诊和曾经疑似感染新冠病毒对于分娩方式的影响。方法本研究是2020年5月15日—2020年9月18日在武汉建立的回顾性队列,研究人群包括确诊感染新冠病毒孕产妇127名,曾经疑似感染新冠病毒孕产妇255名,未感染新冠病毒孕产妇515名。通过比较确诊组和未感染组的分娩方式情况来探索新冠病毒及其次生效应(心理、生活方式等的综合影响)对于分娩方式的影响,通过比较确诊组和曾经疑似组的分娩方式情况来探索新冠病毒本身对于分娩方式的影响。结果确诊组、曾经疑似组和未感染组的剖宫产率分别为74.0%、73.3%和55.5%。在多变量模型中,在以未感染组作为参照时,发现确诊感染新冠病毒(PR:1.36,95%CI:1.19~1.54)和曾经疑似感染新冠病毒(PR:1.24,95%CI:1.11~1.39)均为剖宫产的危险因素;在以曾经疑似组作为参照时,确诊感染新冠病毒(PR:1.09,95%CI:0.96~1.24)与剖宫产无关联。结论确诊和曾经疑似感染新冠病毒可能是剖宫产的危险因素,造成确诊和曾经疑似感染新冠病毒增加剖宫产风险的原因可能是临床上在疫情早期对于疾病的认识不足以及相关医疗设施的缺乏。

Objective To describe the current status of different delivery modes among pregnant women during the COVID-19 pandemic and to investigate the influence of SARS-CoV-2 infection on delivery mode.Methods This study was a retrospective cohort study built in Wuhan between May and September,2020.Three groups of pregnant women had been recruited in this cohort including:127 pregnant women who were confirmed to infect with SARS-CoV-2,255 pregnant women who were preciously suspected to infect with SARS-CoV-2 and 515 uninfected pregnant women.The total effect of SARS-CoV-2 infection and its secondary effect(including influence on mental,lifestyle etc.)was explored by comparing the status of delivery mode in confirmed group and uninfected group.The specific effect of SARS-CoV-2 virus itself was explored by comparing the status of delivery mode in confirmed group and previously suspected group.Results The prevalence of caesarean section in confirmed group,previously suspected group and uninfected group were 74.0%,73.3%and 55.5%.In multivariate model,the SARS-CoV-2 infection(PR:1.36,95%CI:1.19-1.54)and previously suspected infection(PR:1.24,95%CI:1.11-1.39)were associated with caesarean section when uninfected group was taken as the inference group;the SARS-CoV-2 infection(PR:1.09,95%CI:0.96-1.24)was not associated with caesarean section.Conclusion SARS-CoV-2 confirmed infection and previously suspected infection may increase the risk of caesarean section,and the lack of knowledge of SARS-CoV-2 and medical facilities may be the potential reason of the increase.