Maassen Marloes S, Hendrix Marijke J C, Van Vugt Helena C, Veersema Sebastiaan, Smits Frans, Nijhuis Jan G
Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands.
Birth. 2008 Dec;35(4):277-82. doi: 10.1111/j.1523-536X.2008.00254.x.
In The Netherlands, 35 percent of births take place in "primary care" to women considered at low risk and during labor, approximately 30 percent are referred to "secondary care." High-risk women and some low-risk women deliver in secondary care. This study sought to compare planned place of birth and incidence of operative delivery among women at low risk of complications at the time of onset of labor.
A retrospective analysis was conducted of data about births in The Netherlands during 2003 that were recorded routinely in the Netherlands Perinatal Registry. Mode of delivery was analyzed for women classified as low risk at labor onset according to their planned place of birth (intention-to-treat analysis). The primary outcome was the rate of operative deliveries (vacuum or forceps extraction or cesarean section).
Women at low risk who planned to give birth, and therefore labored and delivered in secondary care, had a significantly higher rate of operative deliveries than women who began labor in primary care where they intended to give birth (18% [3,558/19,850] vs 9% [7,803/87,187]) (OR 2.25, 95% CI 2.00-2.52). For cesarean section, the rates were 12 percent (2,419/19,850) versus 3 percent (2,990/87,817) (OR 3.97, 95% CI 3.15-5.01), irrespective of parity.
The rate of operative deliveries was significantly lower for low-risk pregnant women who gave birth in a primary care setting compared with similar women who planned birth in secondary care. As with any retrospective analysis, it was not possible to eliminate bias, such as possible differences between primary and secondary care in assignment of risk status. In addition, known risk factors for interventions, technologies such as induction of labor and fetal monitoring, are only available in secondary care. These findings clearly demonstrate the need for a prospective study to examine the relationship between planned place of birth and mode of delivery and neonatal and maternal outcomes.
在荷兰,35%的分娩是在“初级护理”机构中为低风险女性进行的,而在分娩期间,约30%的产妇被转诊至“二级护理”机构。高危产妇和部分低风险产妇在二级护理机构分娩。本研究旨在比较分娩开始时并发症低风险女性的计划分娩地点和手术分娩发生率。
对2003年荷兰常规记录在荷兰围产期登记处的分娩数据进行回顾性分析。根据计划分娩地点(意向性分析),对分娩开始时被归类为低风险的女性的分娩方式进行分析。主要结局是手术分娩率(真空吸引或产钳助产或剖宫产)。
计划在二级护理机构分娩、因而在二级护理机构分娩的低风险女性的手术分娩率显著高于在其计划分娩的初级护理机构开始分娩的女性(18%[3558/19850]对9%[7803/87187])(比值比2.25,95%置信区间2.00 - 2.52)。对于剖宫产,无论胎次如何,比率分别为12%(2419/19850)和3%(2990/87817)(比值比3.97,95%置信区间3.15 - 5.01)。
与计划在二级护理机构分娩的类似女性相比,在初级护理机构分娩的低风险孕妇的手术分娩率显著更低。与任何回顾性分析一样,不可能消除偏倚,例如初级护理和二级护理在风险状态分配方面可能存在的差异。此外,已知的干预风险因素、诸如引产和胎儿监测等技术仅在二级护理机构可用。这些发现清楚地表明需要进行前瞻性研究,以检查计划分娩地点与分娩方式以及新生儿和产妇结局之间的关系。