Abenhaim Haim A, Morin Lucie, Benjamin Alice, Kinch Robert A
Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Eur J Obstet Gynecol Reprod Biol. 2007 Oct;134(2):164-8. doi: 10.1016/j.ejogrb.2006.10.002. Epub 2006 Nov 16.
To examine the relationship between physicians' instrument preference and obstetrical and neonatal outcomes.
A retrospective cohort study comparing obstetrical and neonatal outcomes of second stage deliveries between obstetricians who prefer forceps (forceps >/=90%) with obstetricians with no preference to forceps (either instrument <90%) was completed using the McGill Obstetrical and Neonatal Database. Logistic regression analysis was used to obtain an adjusted odds ratio controlling for maternal, intrapartum and neonatal confounders.
Two thousand and three hundred thirteen infants were delivered by 5 obstetricians who preferred forceps, and 9261 infants were delivered by 15 obstetricians with no instrument preference. Baseline characteristics were similar between the two groups. As compared to obstetricians who preferred forceps, obstetricians with no instrument preference had a higher rate of operative vaginal deliveries 1.5 (1.1-2.0), a higher cesarean section rate 2.5 (1.3-4.9) and a higher episiotomy rate in non-operative vaginal deliveries 3.4 (2.7-4.3). Infants delivered by obstetricians with no instrument preference were less likely to have significant bruising 0.3 (0.2-0.6) but more likely to have a cephalohematoma 3.0 (1.1-8.3).
Physician instrument preference is an important determinant of outcomes that should be considered in studies evaluating instrumental deliveries.
探讨医生器械偏好与产科及新生儿结局之间的关系。
使用麦吉尔产科和新生儿数据库完成一项回顾性队列研究，比较偏好产钳（产钳使用率≥90%）的产科医生与无器械偏好（两种器械使用率均<90%）的产科医生进行第二产程分娩的产科及新生儿结局。采用逻辑回归分析来获得调整后的优势比，以控制产妇、产时及新生儿混杂因素。
5名偏好产钳的产科医生接生了2313名婴儿，15名无器械偏好的产科医生接生了9261名婴儿。两组的基线特征相似。与偏好产钳的产科医生相比，无器械偏好的产科医生手术阴道分娩率更高（1.5[1.1 - 2.0]），剖宫产率更高（2.5[1.3 - 4.9]），非手术阴道分娩时会阴切开率更高（3.4[2.7 - 4.3]）。无器械偏好的产科医生接生的婴儿出现明显瘀伤的可能性较小（0.3[0.2 - 0.6]），但发生头颅血肿的可能性较大（3.0[1.1 - 8.3]）。
医生的器械偏好是结局的一个重要决定因素，在评估器械助产的研究中应予以考虑。
