Oppenheimer Lawrence W, Holmes Paul, Yang Qiuying, Yang Tubao, Walker Mark, Wu Wen Shi
Division of Maternal-Fetal Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.
Am J Perinatol. 2007 May;24(5):271-5. doi: 10.1055/s-2007-976547. Epub 2007 May 4.
The purpose of this study was to investigate to what extent the Society of Obstetricians and Gynecologists of Canada (SOGC) guidelines on dystocia are being followed, and whether adherence to the guidelines is related to cesarean section rates. Data were extracted from a maternity database for nulliparous women with singleton, cephalic pregnancies at 37 or more completed weeks of gestation for a 4-year period. Patients delivered by elective cesarean section were excluded. Data were examined to determine whether those who had a cesarean section for dystocia in the first stage of labor fulfilled SOGC guidelines. In addition, the obstetricians were divided into two groups (high or low) according to their cesarean section rate for dystocia to determine whether a higher section rate was associated with an increased guideline violation rate. There were 239 nulliparous women who had a cesarean section for dystocia in the first stage of labor. The guidelines were followed in 47.7% of spontaneous labors and 77.5% of inductions. The mean section rate for dystocia in the first stage of labor was 10.8% in the high group and 6.6% in the low group, and the incidence of guideline violations in these groups was 48.0% and 39.6%, respectively ( P = 0.07). The study had a power of 0.88 to detect a 40% difference in guideline violation rates between the two groups. We conclude that many women have cesarean section for dystocia performed without fulfilling SOGC guidelines.
本研究的目的是调查加拿大妇产科医师协会（SOGC）难产指南的遵循程度，以及遵循该指南是否与剖宫产率相关。数据取自一个产妇数据库，该数据库涵盖了4年期间妊娠37周或以上、单胎、头位妊娠的初产妇。择期剖宫产分娩的患者被排除在外。对数据进行检查，以确定那些在第一产程因难产而行剖宫产的患者是否符合SOGC指南。此外，根据产科医生因难产而行剖宫产的比例将其分为两组（高或低），以确定较高的剖宫产率是否与更高的指南违反率相关。有239名初产妇在第一产程因难产而行剖宫产。在自然分娩中，47.7%遵循了指南，在引产中，77.5%遵循了指南。第一产程因难产而行剖宫产的平均比例在高分组为10.8%，在低分组为6.6%，这些组中违反指南的发生率分别为48.0%和39.6%（P = 0.07）。该研究有88%的检验效能来检测两组之间指南违反率40%的差异。我们得出结论，许多因难产而行剖宫产的女性并未遵循SOGC指南。
