Schlotter C M, Wichert S A, Settatree R S, Wassmann K
Frauenklinik, Klinikum Ibbenbüren, Germany.
Zentralbl Gynakol. 2002 Apr;124(4):202-6. doi: 10.1055/s-2002-32433.
Aim of the study was to assess whether different birth management of an english and german department can influence the maternal and neonatal outcome.
The database consisted of routinely published data from 1986-95 for two clinical units in Solihull (England) and Ibbenbueren (Germany) comprising 34 820 and 9 053 deliveries respectively. In order to standardise the obstetric risk profiles the heterogeneous primary groups were subdivided into "standard primip groups". A statistical comparison using the "binomial confidence interval method" was carried out.
In the standardised comparison induction of labour, duration of labour 1-6 hours, vaginal delivery from cephalic presentation, elective caesarean section, both for cephalic and breech presentation, transfer to the childrens hospital were less frequent in Solihull. On the other hand, Solihull showed more frequent oxytocin administration, fetal blood analysis, epidural anaesthesia, episiotomies, duration of labour > 13 hours, forceps, ventouse and emergency caesarean section deliveries from cephalic presentation, vaginal deliveries or emergency caesarean sections from breech presentation, resuscitation of the newborn using mask and/or drugs, maternal blood loss > 1 000 ml as well as abnormalities of placental separation. Despite the different management of the departments being compared no significant differences in the incidence of perinatal hypoxia as determined by Apgar scores at 5 minutes nor in the fetal mortality rate between the units could be identified.
Using standardised data the quality of obstetric and perinatal care in England and Germany can be reliably compared. Different birth management does not significantly influence the neonatal outcome.
本研究旨在评估英国和德国两个科室不同的分娩管理方式是否会影响母婴结局。
数据库包含1986 - 1995年索利哈尔（英国）和伊本比伦（德国）两个临床单元定期发布的数据，分别包括34820例和9053例分娩。为了使产科风险概况标准化，将异质性的初级组细分为“标准初产妇组”。采用“二项式置信区间法”进行统计比较。
在标准化比较中，索利哈尔的引产、1 - 6小时产程、头位阴道分娩、择期剖宫产（包括头位和臀位）、转至儿童医院的情况较少。另一方面，索利哈尔使用催产素、进行胎儿血液分析、硬膜外麻醉、会阴切开术、产程超过13小时、使用产钳、胎头吸引器以及头位紧急剖宫产、臀位阴道分娩或紧急剖宫产、使用面罩和/或药物对新生儿进行复苏、产妇失血超过1000毫升以及胎盘剥离异常的情况更为频繁。尽管所比较的科室管理方式不同，但在5分钟时通过阿氏评分确定的围产期缺氧发生率以及各单元之间的胎儿死亡率方面未发现显著差异。
使用标准化数据可以可靠地比较英国和德国的产科及围产期护理质量。不同的分娩管理方式对新生儿结局没有显著影响。
