Fischer Angela, LaCoursiere D Yvette, Barnard Peter, Bloebaum Lois, Varner Michael
Department of Obstetrics and Gynecology, University of Utah School of Medicine, and Utah Department of Health, Salt Lake City 84108, USA.
Obstet Gynecol. 2005 Apr;105(4):816-21. doi: 10.1097/01.AOG.0000156299.52668.e2.
The purpose of this study was to quantify patient populations and practice patterns at perinatal centers with the highest and lowest cesarean delivery rates.
The 2 perinatal centers in our state with the lowest (Hospital A-16.6%) and highest (Hospital B-20.3%) overall cesarean rates for Robson group 1 (term primigravidas, vertex, spontaneous labor) and group 2 (term primigravidas, vertex, induced labor) were identified. A total of 174 medical records at Hospital A and 150 records at Hospital B were reviewed. Statistical analysis was performed using independent-sample t tests, chi(2), and multiple logistic regression.
Indications for cesarean delivery were not different between the 2 groups, with the majority being for failure to progress in labor and nonreassuring fetal status. There were no differences between groups in rates of postpartum hemorrhage, chorioamnionitis, or endometritis. There were no differences in neonatal outcomes. Although women delivering in hospital A were not more likely to receive oxytocin augmentation (P = .291), their mean maximal oxytocin dosage was higher (14.5 units compared with 11.6 units, P < .001), and they were more likely to receive both fetal scalp electrodes (60.9% compared with 37.3%, P < .001) and intrauterine pressure catheters (63.8% compared with 26.0%, P < .001).
Because safe reduction in cesarean delivery rates for primigravidas will proportionately reduce the number of repeat cesarean delivery required, benchmarking practices as described in this study can be considered in obstetric practices interested in long-term reductions of their cesarean delivery rates.
III.
本研究旨在量化剖宫产率最高和最低的围产期中心的患者群体及医疗实践模式。
确定了本州剖宫产率最低（医院A - 16.6%）和最高（医院B - 20.3%）的两个围产期中心，这两个中心针对罗布森分类法中的第1组（足月初产妇、头先露、自然分娩）和第2组（足月初产妇、头先露、引产）。对医院A的174份病历和医院B的150份病历进行了回顾。采用独立样本t检验、卡方检验和多因素逻辑回归进行统计分析。
两组间剖宫产指征无差异，多数指征为产程进展不佳和胎儿状况不良。两组间产后出血、绒毛膜羊膜炎或子宫内膜炎的发生率无差异。新生儿结局也无差异。虽然在医院A分娩的女性接受缩宫素加强宫缩的可能性并不更高（P = 0.291），但其缩宫素平均最大剂量更高（分别为14.5单位和11.6单位，P < 0.001），且她们更有可能接受胎儿头皮电极监测（分别为60.9%和37.3%，P < 0.001）以及宫腔压力导管监测（分别为63.8%和26.0%，P < 0.001）。
由于初产妇剖宫产率的安全降低将相应减少所需的再次剖宫产数量，对于希望长期降低剖宫产率的产科实践，可考虑采用本研究中描述的基准实践。
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