Draycott Tim, Sibanda Thabani, Owen Louise, Akande Valentine, Winter Cathy, Reading Sandra, Whitelaw Andrew
Women's and Children's Directorate, Southmead Hospital, and Department of Clinical Science at North Bristol, University of Bristol, UK.
BJOG. 2006 Feb;113(2):177-82. doi: 10.1111/j.1471-0528.2006.00800.x.
To determine whether the introduction of Obstetrics Emergency Training in line with the recommendations of the Clinical Negligence Scheme for Trusts (CNST) was associated with a reduction in perinatal asphyxia and neonatal hypoxic-ischaemic encephalopathy (HIE).
A retrospective cohort observational study.
A tertiary referral maternity unit in a teaching hospital.
Term, cephalic presenting, singleton infants born at Southmead Hospital between 1998 and 2003 were identified; those born by elective Caesarean sections were excluded.
Five-minute Apgar scores were reviewed. Infants that developed HIE were prospectively identified throughout this period. The study compared the period 'pre-training' (1998-1999), with the period 'post-training' (2001-2003).
Five-minute Apgar scores and HIE.
Infants (19,460) were included. Infants born with 5-minute Apgar scores of <or=6 decreased from 86.6 to 44.6 per 10,000 births (P<0.001) and those with HIE decreased from 27.3 to 13.6 per 10,000 births (P=0.032) following the introduction of the training courses in 2000. Antepartum and intrapartum stillbirth at term rates remained unchanged, at about 15 and 4 per 10,000 births, respectively.
The introduction of obstetric emergencies training courses was associated with a significant reduction in low 5-minute Apgar scores and HIE. This improvement has been sustained as the training has continued. This is the first time an educational intervention has been shown to be associated with a clinically important, and sustained, improvement in perinatal outcome.
确定按照信托机构临床过失方案（CNST）的建议引入产科急救培训是否与围产期窒息和新生儿缺氧缺血性脑病（HIE）的减少有关。
一项回顾性队列观察研究。
一家教学医院的三级转诊产科病房。
确定1998年至2003年在南米德医院出生的足月、头先露、单胎婴儿；排除择期剖宫产出生的婴儿。
回顾5分钟阿氏评分。在此期间前瞻性地确定发生HIE的婴儿。该研究比较了“培训前”时期（1998 - 1999年）和“培训后”时期（2001 - 2003年）。
5分钟阿氏评分和HIE。
纳入婴儿19460例。2000年引入培训课程后，5分钟阿氏评分≤6分的婴儿出生比例从每10000例出生86.6例降至44.6例（P<0.001），HIE婴儿出生比例从每10000例出生27.3例降至13.6例（P = 0.032）。足月产前和产时死产率保持不变，分别约为每10000例出生15例和4例。
引入产科急救培训课程与5分钟低阿氏评分和HIE的显著降低有关。随着培训的持续，这种改善得以维持。这是首次证明教育干预与围产期结局在临床上具有重要意义且持续的改善相关。
