Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden.
BJOG. 2010 Jul;117(8):968-78.
To increase our knowledge of the occurrence of substandard care during labour.
A population-based case-control study.
Stockholm County.
Infants born in the period 2004-2006 in Stockholm County.
Cases and controls were identified from the Swedish Medical Birth Register, had a gestational age of +/-33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of < 7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth.
Substandard care during labour.
We found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for > or = 45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated.Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care.
There was substandard care during labour of two thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.
提高我们对分娩期间护理不足发生率的认识。
基于人群的病例对照研究。
斯德哥尔摩县。
斯德哥尔摩县 2004-2006 年出生的婴儿。
从瑞典医疗出生登记处确定病例和对照，胎龄为 +/-33 周完整，计划阴道分娩，入院时正常心电图（CTG）记录。我们比较了 313 名出生 5 分钟时 Apgar 评分<7 的婴儿和 313 名随机选择的 Apgar 评分完全正常的对照，这些对照与出生年份相匹配。
分娩期间的护理不足。
我们发现，62%的病例和 36%的对照在分娩期间存在某种形式的护理不足。在一半的病例和 12%的对照中，在分娩前>或=45 分钟时 CTG 异常。当需要时，胎儿血样采集在病例和对照中均未进行（79%）。催产素在病例和对照中均未出现子宫乏力迹象（20%）。催产素引起子宫收缩过度刺激在病例中为 29%，在对照中为 9%，并且尽管 CTG 异常，病例和对照中分别有 19%和 6%增加了催产素剂量。假设护理不足是低 Apgar 评分的危险因素，我们估计通过避免护理不足，可以预防多达 42%的病例。
低 Apgar 评分的婴儿中有三分之二存在护理不足。护理不足的主要原因与 CTG 解读错误、未能及时处理异常 CTG 以及谨慎使用催产素有关。
