From the Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland; the Global Health Initiative, Yale University, and the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; and the Departments of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
Obstet Gynecol. 2011 Dec;118(6):1239-1246. doi: 10.1097/AOG.0b013e31823835d3.
To compare neonatal neurologic complication rates of cesarean deliveries, forceps-assisted vaginal deliveries, and vacuum-assisted vaginal deliveries.
Data on singleton live births at 34 weeks or greater gestation born to nulliparous women from 1995 to 2003 in New York City were linked to hospital discharge data. Any diagnosis of neonatal subdural hemorrhage, intraventricular hemorrhage, seizures, scalp laceration or cephalohematoma, fracture, facial nerve palsy, brachial plexus injury, or 5-minute Apgar score of less than 7 was considered significant. Multivariable logistic regression was used to estimate associations between delivery mode and these neonatal morbidities.
Forceps-assisted vaginal deliveries were associated with significantly fewer seizures and 5-minute Apgar scores less than 7 compared with vacuum-assisted vaginal deliveries and cesarean deliveries. Cesarean deliveries were linked to less subdural hemorrhages compared with forceps-assisted vaginal deliveries or vacuum-assisted vaginal deliveries. When seizure, intraventricular hemorrhage, and subdural hemorrhage were examined collectively to best predict neurologic outcome, forceps-assisted vaginal deliveries had an overall reduced risk compared with both vacuum-assisted vaginal deliveries (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.40-0.90) and cesarean deliveries (OR 0.68, 95% CI 0.48-0.97). The number needed to treat to prevent one case of severe neurologic morbidity is 509 for forceps-assisted vaginal deliveries compared with vacuum-assisted vaginal deliveries and 559 for forceps-assisted vaginal deliveries compared with cesarean deliveries.
Compared with vacuum-assisted vaginal delivery or cesarean delivery, a forceps-assisted vaginal delivery is associated with a reduced risk of adverse neonatal neurologic outcomes.
II.
比较剖宫产、产钳助产和真空吸引助产的新生儿神经系统并发症发生率。
1995 年至 2003 年，纽约市对 34 周或以上胎龄的初产妇的单胎活产儿数据与医院出院数据进行了关联。任何新生儿硬膜下出血、脑室出血、癫痫发作、头皮裂伤或头皮血肿、骨折、面神经瘫痪、臂丛神经损伤或 5 分钟 Apgar 评分低于 7 的诊断均被认为是显著的。多变量逻辑回归用于估计分娩方式与这些新生儿疾病之间的关联。
与真空吸引助产和剖宫产相比，产钳助产与更少的癫痫发作和 5 分钟 Apgar 评分低于 7 相关。与产钳助产或真空吸引助产相比，剖宫产与较少的硬膜下血肿相关。当将癫痫发作、脑室出血和硬膜下血肿一起检查以最佳预测神经结局时，与真空吸引助产相比，产钳助产的总体风险降低（比值比 [OR] 0.60，95%置信区间 [CI] 0.40-0.90）和剖宫产（OR 0.68，95%CI 0.48-0.97）。产钳助产可预防 1 例严重神经系统疾病的治疗人数为 509 例，与真空吸引助产相比，与剖宫产相比，治疗人数为 559 例。
与真空吸引助产或剖宫产相比，产钳助产与新生儿不良神经结局的风险降低相关。
II 级。
