Ben-Haroush Avi, Melamed Nir, Kaplan Boris, Yogev Yariv
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.
Am J Obstet Gynecol. 2007 Sep;197(3):308.e1-5. doi: 10.1016/j.ajog.2007.06.051.
The purpose of this study was to identify factors that predict operative vaginal delivery.
A retrospective cohort study was conducted that included all women who underwent a trial of operative vaginal delivery between 1993 and 2006 at a major tertiary center.
Operative vaginal delivery was attempted in 5120 of 83,351 deliveries (6.1%): 4299 vacuum extractions (84.0%) and 821 forceps deliveries (16.0%). Failures occurred in 8.6% of trials, more often with vacuum extraction (10.0% vs 1.3%; P < .001). Most vacuum extraction failures (72.6%) were followed by a trial of forceps delivery, which failed in 3.5% of cases. On multivariate logistic regression analysis, the use of forceps (vs vacuum; odds ratio [OR], 0.4; 95%CI, 0.2-0.7) and administration of analgesia (epidural: OR, 0.4 [95% CI, 0.2-0.7]; intravenous opiates: OR, 0.2 [95%CI, 0.1-0.6]) were associated with a lower risk of failure, persistent occiput posterior position (OR, 2.2; 95% CI, 1.4-3.5) and birthweight >4000 g (OR, 2.8; 95% CI, 1.6-4.9), with a higher risk.
Fetal weight and head position should be evaluated carefully before operative vaginal delivery, and the use of analgesia should be encouraged.
本研究旨在确定预测手术阴道分娩的因素。
进行了一项回顾性队列研究，纳入了1993年至2006年期间在一家大型三级医疗中心接受手术阴道分娩试验的所有女性。
在83351例分娩中有5120例尝试进行手术阴道分娩（6.1%）：4299例真空吸引术（84.0%）和821例产钳助产（16.0%）。8.6%的试验失败，真空吸引术失败的情况更常见（10.0%对1.3%；P <.001）。大多数真空吸引术失败（72.6%）后进行了产钳助产试验，其中3.5%的病例失败。多因素逻辑回归分析显示，使用产钳（与真空吸引术相比；比值比[OR]，0.4；95%置信区间[CI]，0.2 - 0.7）和使用镇痛剂（硬膜外麻醉：OR，0.4[95%CI，0.2 - 0.7]；静脉注射阿片类药物：OR，0.2[95%CI，0.1 - 0.6]）与较低的失败风险相关，持续性枕后位（OR，2.2；95%CI，1.4 - 3.5）和出生体重>4000 g（OR，2.8；95%CI，1.6 - 4.9）与较高的失败风险相关。
在进行手术阴道分娩前应仔细评估胎儿体重和胎位，并鼓励使用镇痛剂。
