From the Departments of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Alabama at Birmingham, Birmingham, Alabama; the Ohio State University, Columbus, Ohio; the University of Utah, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University Health Sciences, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; the University of Cincinnati, Cincinnati, Ohio; the University of Miami, Miami, Florida; the University of Tennessee, Memphis, Tennessee; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Vanderbilt University, Nashville, Tennessee; the George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Obstet Gynecol. 2009 Nov;114(5):1017-1022. doi: 10.1097/AOG.0b013e3181bbf3be.
To compare maternal and neonatal outcomes in women undergoing second-stage cesarean delivery after a trial of operative vaginal delivery with those in women undergoing second-stage cesarean delivery without such an attempt.
This study is a secondary analysis of the women who underwent second-stage cesarean delivery. The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death. Neonatal outcomes examined included umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, seizures within 24 hours of birth, hypoxic ischemic encephalopathy, stillbirth, skull fracture, and neonatal death.
Of 3,189 women who underwent second-stage cesarean delivery, operative vaginal delivery was attempted in 640. Labor characteristics were similar in the two groups, with the exception of the admission-to-delivery time and cesarean indication. Those with an attempted operative vaginal delivery were more likely to undergo cesarean delivery for a nonreassuring fetal heart rate tracing (18.0% compared with 13.9%, P=.01), have a wound complication (2.7% compared with 1.0%, odds ratio [OR] 2.65, 95% confidence interval [CI] 1.43-4.91), and require general anesthesia (8.0% compared with 4.1%, OR 2.05, 95% CI 1.44-2.91). Neonatal outcomes, including umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, and hypoxic ischemic encephalopathy, were more common for those with an attempted operative vaginal delivery. This was not significant when cases with a nonreassuring fetal heart rate tracing were removed.
Cesarean delivery after an attempt at operative vaginal delivery was not associated with adverse neonatal outcomes in the absence of a nonreassuring fetal heart rate tracing.
II.
比较行阴道助产尝试后行第二阶段剖宫产与未行阴道助产尝试直接行第二阶段剖宫产的产妇及新生儿结局。
本研究为二次分析行第二阶段剖宫产的产妇。观察的产妇结局包括输血、子宫内膜炎、伤口并发症、麻醉使用和产妇死亡。观察的新生儿结局包括脐动脉 pH 值小于 7.0、5 分钟时 Apgar 评分为 3 分或更低、出生后 24 小时内癫痫发作、缺氧缺血性脑病、死胎、颅骨骨折和新生儿死亡。
在 3189 例行第二阶段剖宫产的产妇中，有 640 例行阴道助产尝试。两组的产程特征相似，除了入院至分娩时间和剖宫产指征。行阴道助产尝试的产妇更有可能因胎心监护图不典型而行剖宫产（18.0%比 13.9%，P=0.01），伤口并发症更多（2.7%比 1.0%，比值比[OR] 2.65，95%置信区间[CI] 1.43-4.91），且需要全身麻醉（8.0%比 4.1%，OR 2.05，95% CI 1.44-2.91）。行阴道助产尝试的新生儿结局，包括脐动脉 pH 值小于 7.0、5 分钟时 Apgar 评分为 3 分或更低和缺氧缺血性脑病，更为常见。去除胎心监护图不典型的病例后，这种差异没有统计学意义。
在没有胎心监护图不典型的情况下，行阴道助产尝试后行剖宫产与不良新生儿结局无关。
Ⅱ级。
